Compositions comprising secreted extracellular vesicles of cells expressing NFATC4 useful for the treatment of cancer

ABSTRACT

The present invention relates to a composition comprising secreted extracellular vesicles (SEV) of cells expressing nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4(NFATC4), for use in the treatment of cancer or in the treatment or prevention of metastatic cancer. It further relates to in vitromethods for determining or predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, based on the ability of the composition comprising SEV of cells expressing NFATC4 to induce an increase in TGFβ1 expression level.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a U.S. National Stage Application pursuant to 35 U.S.C. § 371 of International Patent Application PCT/EP2017/057374, filed on Mar. 29, 2017, and published as WO 2017/167788 on Oct. 5, 2017, which claims priority to European Patent Application 16305362.2, filed on Mar. 29, 2016, all of which are incorporated herein by reference in their entireties for all purposes.

TECHNICAL FIELD OF THE INVENTION

The present invention is in the field of oncology, and more particularly to the treatment of cancer and metastatic cancer. It relates to a composition comprising secreted extracellular vesicles (SEV) of cells expressing nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4 (NFATC4), for use in the treatment of cancer or in the treatment or prevention of metastatic cancer. It further relates to in vitro methods for determining or predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, based on the ability of the composition comprising SEV of cells expressing NFATC4 to induce an increase in TGFß1 expression level.

BACKGROUND ART

Breast cancer is a leading cause of morbidity in women worldwide. The main reason of death for these patients is not the primary tumor, but distant metastases, which are directly linked to the migratory and invasive phenotype of the cancer cells. In addition, de novo and acquired resistance to anticancer agents remains a major obstacle in the treatment of breast cancer. Moreover, resistance to treatment is often associated to increased invasiveness of cancer and development of metastasis, suggesting that some treatment, while initially efficient to treat the primary cancer, at the same time promote the appearance of more invasive cells, finally resulting in metastasis combined to resistance to treatment. The same is true for other cancers. There is thus a need for new therapies that would be efficient not only on the primary cancer but that would also inhibit the development of invasiveness and metastasis.

Moreover, it is now well known that no therapy is efficient in all patients, a varying proportion of patients being resistant to any given therapy. In order to prevent long-term administration of a non-efficient treatment (which is not only costly but also detrimental to the patient's health), there is also a need for tests with the ability to predict or at least to determine efficiency of a given therapy for a given patient, before or just after treating the patient.

Different studies revealed that secreted extracellular vesicles (SEV) can be readily detected in tumor tissue and many body fluids, and are found in higher concentrations, both in tumor tissue, and in the serum and plasma of cancer patients (Tickner et al. Front Oncol 4, 127 (2014)).

Secreted extracellular vesicles (SEV), is the general term to designate cell secreted vesicles ranging approximately 40 nm to few μm in size. Among them, exosomes comprise the most prominently described classes of SEV. Exosomes have a diameter lower than about 150 nm and are derivatives of the endosomal compartment. SEV contain cytosolic and membrane proteins derived from the parental cells. The protein content of SEV depends on their cellular origin and SEV are enriched for certain molecules, especially endosome-associated proteins (e.g. CD63) and proteins involved in multivesicular bodies formation, but also contain targeting/adhesion molecules. Remarkably, SEV contain not only proteins but also functional mRNAs, long non-coding RNAs and miRNAs, and in some cases, they have been shown to deliver these genetic materials to recipient cells.

The cargo of SEV is potentially particularly interesting for targeting therapies to tumors, as SEV are secreted in the extracellular compartment, where their content is protected from degradation because of their lipid membrane, and SEV excreted from one cell are known to be able to fuse with surrounding cells, and thus have the potential to initiate signaling responses (Hendrix, A. et al. Cancer Res. 70, 9533-9537 (2010).).

However, cancer cell derived SEV have been shown by many to be involved in cancer progression and metastasis (van der Pol E. et al. Pharmacol Rev 64:A-AD, 2012). It has notably been shown that SEV function as versatile promoters in the tumorigenesis, metastasis and drug resistance of breast cancer (Yu et al. Cancer Sci 106 (2015) 959-964). Similarly, studies using tumor-derived SEV exposing a membrane-bound luciferase fused to the C1C2-domain of MFGE8/lactadherin27 show a half-life of only two minutes in blood circulation. Several hours after they had disappeared from the circulation, SEV were recovered in spleen, and melanoma-derived SEV also accumulated in lung, liver, and bone marrow—organs thought to be preferred sites of metastasis (Peinado, H. et al. Nat. Med. 18, 883-891 (2012); Takahashi, Y. et al. J. Biotechnol. 165, 77-84 (2013).). Another study has recently shown that SEV from MDA-MB-231 can be transferred in vivo to T47D cell to enhance their invasion (Zomer, A. et al. Cell 161, 1046-1057 (2015).). This is of particular relevance in tumorigenesis, as both surrounding and distant tissues are known to adopt characteristics of the primary tumor. A recent study has paved the way showing that breast cancer SEV are the site of pre-miRNA maturation to promote tumor growth (Melo, S. A. et al. Cancer Cell 26, 707-721 (2014).). The use of cancer cells derived SEV appears rather deleterious than helpful for cancer treatment.

As a result, most attempts for treating cancer using SEV have relied on the idea to prompt an immune response against cancer-specific material, using antigen presenting cells (APC)-derived SEV (in particular dendritic cells(DC)-derived exosomes, which are enriched in molecules useful for priming immune responses), loaded with tumor-specific peptides. While some immune responses have been observed, the observed treatment efficiency was generally low (van der Pol E. et al. Pharmacol Rev 64:A-AD, 2012).

The family of NFAT transcription factors comprises five genes.

Molecular pathways involving specific members of the NFAT family have been highlighted in the migratory and invasive capacities of breast cancer cells (Jauliac S, et al. (2002). Nat Cell Biol 4: 540-544). Moreover, there is growing evidence for a function of the NFAT factors in carcinogenesis (Mancini M, Toker A. (2009). Nat Rev Cancer 9: 810-820). NFATC4 (also known as NFAT3) has been shown to inhibit breast cancer cell motility by targeting the Lipocalin 2 gene. In particular, it has been shown that NFAT3 is specifically expressed in estrogen receptor a positive (ERA+) breast cancer cells of low invasive capacity, and that transduction with a vector of expression of NFAT3 inhibits invasion of both ERA+ (low invasive capacity) and ERA− (high invasive capacity) breast cancer cells (Fougère, M., et al. (2010). Oncogene, 29(15), 2292-2301).

However, while SEV composition is influenced by the cell secreting it, the molecular composition of SEV is not a mere reflection of the cell secreting it. In contrast, SEV are enriched in specific proteins, lipids and RNAs, whereas others are absent, indicating the existence of specialized mechanisms that control the sorting of molecules into SEV (Villarroya-Beltri C. et al. Semin Cancer Biol. 2014 October; 28: 3-13; Al-Nedawi, K. et al. Nature Publishing Group 10, 619-624 (2008); Ohshima, K. et al. PLoS ONE 5, e13247 (2010); Soldevilla, B. et al. Hum. Mol. Genet. 23, 467-478 (2014)). In particular, SEV are known to contain transmembrane receptors of the cell secreting them, and in particular oncogenic transmembrane receptors such as EGFRvIII (Al-Nedawi, K. et al. Nature Publishing Group 10, 619-624 (2008)). However, the presence in SEV of transcription factors of the cell secreting them cannot be guaranteed. For instance, Al-Nedawi, K. et al showed that while EGFRvIII+ glioma cells SEV contain oncogenic transmembrane receptor EGFRvIII and transmit it to other EGFRvIII− glioma cells, EGFRvIII effectors, such as Erk1/2 and Akt, were largely undetectable in SEV.

Moreover, it has also been shown that SEV secreted by breast cancer cell lines of both low and high invasive capacity promote cell migration (Harris D A, et al. PLoS ONE 10(3): e0117495.), suggesting that such SEV would rather promote cancer progression and invasion.

SUMMARY OF THE INVENTION

In the context of the present invention, the inventors surprisingly found that, contrary to SEV produced by human fibroblasts or by a highly invasive breast cancer cell line, SEV secreted by low invasive breast cancer cells, which express NFATC4, do not promote cancer progression and invasion but instead inhibit invasion in vitro and inhibit tumor growth and metastasis in an in vivo xeno-transplantation model. The inventors also surprisingly found that the inhibitory effect of SEV produced by low invasive breast cancer cells on the invasive capacity of highly invasive cell lines requires the expression of NFATC4 in the low invasive SEV-producing cells.

The inventors further unexpectedly found that the expression of NFATC4 in the low invasive SEV-producing cells results in de novo induction of TGFβ1 expression in highly invasive breast cancer cell lines, which is required for the SEV to modulate breast cancer cell invasion in vitro and is correlated to treatment efficiency in vivo. Increase of TGFβ1 concentration in patients administered with SEV produced by low invasive cancer cells might thus be used as a biomarker of therapeutic efficiency of the treatment.

In a first aspect, the present invention thus relates to a composition comprising secreted extracellular vesicles (SEV) of cells expressing nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4 (NFATC4), for use in the treatment of cancer or in the treatment or prevention of metastatic cancer.

In a second aspect, the present invention also relates to a method for preparing a composition comprising SEV of cells expressing NFATC4 from a sample of cells, comprising:

-   -   a) Inducing NFATC4 expression or activity in said cells;     -   b) Culturing said induced cells in SEV-free culture medium,         under conditions permitting their expansion; and     -   c) Purifying SEV of the induced cells.

In a third aspect, the present invention also relates to an in vitro method for determining the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a treated cancer patient, from a first biological sample of said cancer patient taken before the beginning of the treatment and a second corresponding biological sample of cancer patient after the beginning of the treatment, comprising:

-   -   a) Measuring in vitro at least the Transforming growth factor         beta 1 (TGFß1) expression level in said first and second         biological samples;     -   b) Comparing the measured TGFß1 expression levels; and     -   c) Determining the efficiency of the treatment with a         composition comprising SEV of cells expressing NFATC4 in said         treated cancer patient from said comparison, wherein the         treatment is considered efficient if the TGFß1 expression level         measured in the biological sample after the beginning of the         treatment is higher than the TGFß1 expression level in the         biological sample before the beginning of the treatment.

In a fourth aspect, the present invention also relates to an in vitro method for predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, from a cancer sample of said cancer patient, comprising:

-   -   a) Measuring in vitro at least the TGFß1 expression level in         said tumor sample;     -   b) Incubating said cancer sample with a composition comprising         SEV expressing NFATC4;     -   c) Measuring in vitro at least the TGFß1 expression level in         said tumor sample incubated with a composition comprising SEV by         cells expressing NFATC4; and     -   d) Predicting efficiency of a treatment with a composition         comprising SEV of cells expressing NFATC4 in said cancer patient         if at least the TGFß1 expression level measured in step c) is         higher than at least the TGFß1 expression level measured in step         a), and predicting non efficiency of a treatment with a         composition comprising SEV of cells expressing NFATC4 in said         cancer patient if at least the TGFß1 expression level measured         in step c) is lower or equal at least to the TGFß1 expression         level measured in step a).

DESCRIPTION OF THE FIGURES

FIG. 1. Characterization by size and specific markers of SEV produced by T47D and MDA-MB-231 cells. Representative examples of size distribution of SEV produced by MDA-MB-231 (A) and T47D (B), evaluated by the NanoSight. SEV concentration (particles/ml:pp/mL) is shown in function of particle size (nm). (C) Western blot for SEV characterization: whole cells protein extract was compared to the SEV protein fraction for both cells types using antibodies against Calnexin; CD63 and CD81.

FIG. 2. SEV produced by low invasive T47D and MCF7 cells inhibit invasion of highly invasive MDA-MB-231 and SUM159PT breast cancer cells and WM.266.4 melanoma cells. (A) MDA-MB-231 were treated for 24 h with either 3.75×10⁸ pp SEV produced by WT T47D or by WT MDA-MB-231 or by 2 different primary dermal fibroblasts (FHN21, FHN32) obtained from 2 different women skin and subjected to an in vitro invasion assay for 6 h (n=2; *p<0.05). The invasion index is calculated as a proportion of the number of invasive cells in treated wells compared to the number of invasive cells in the control well arbitrarily set to 1. (B) Melanoma cell line (WM.266.4) were treated for 24 h with 3.75×10⁸ pp SEV produced by WT T47D and subjected to an in vitro invasion assay for 6 h (n=3; **p<0.005). (C) MDA-MB-231 were treated for 24 h with either 3.75×10⁸ pp SEV produced by WT T47D or by WT MCF7 and subjected to an in vitro invasion assay for 6 h (n=3; ***p<0.0005). (D) SUM-159-PT were treated for 24 h with either 3.75×10⁸ pp SEV produced by WT T47D or by WT MCF7 and subjected to an in vitro invasion assay for 6 h (n=3; ***p<0.0005).

FIG. 3. SEV from low invasive breast cancer cells do not modify the proliferation of highly invasive breast cancer cells. Highly invasive MDA-MB-231 (n=2) (A) were treated for 24 h and SUM-159-PT (n=2) (B) were treated for 24, 48 and 72 h with the indicated amount of SEV from T47D-WT to evaluate cell proliferation either by BrdU incorporation (A) or direct cell counting (B). (C) Highly invasive MDA-MB-231 were treated for 48 h with SEV from T47D-WT to evaluate cell apoptosis (n=2).

FIG. 4. The inhibitory effect of the SEV on the invasive capacity of high invasive cell lines (MDA-MB-231 and SUM-159-PT) requires the expression of NFAT3 in the low invasive SEV-producing cell line T47D. (A) Western blot of T47D cells expressing either shCtrl, shNFAT3-3 or shNFAT3-4. Whole cell lysate were revealed by an anti-NFAT3 and amount of protein was normalized by revelation with an anti-actin. Highly invasive MDA-MB-231 (B) or SUM159PT (C) cells were pre-treated or not with SEV produced by low invasive T47D breast cancer cell line WT or stably expressing shRNA that reduce to 50% the expression of endogenous NFAT3 (shNFAT3-3, shNFAT3-4) and as a control a shRNA control (shCtrl) and tested for their invasive capacity (n=3,**p<0.005). The invasion index is calculated as a proportion of the number of invasive cells in treated wells compared to the number of invasive cells in the control well arbitrarily set to 1.

FIG. 5. De novo Induction of TGFb1 in MDA-MB-231 cells is required for the SEV to modulate breast cancer cell invasion. (A) MDA-MB-231 were incubated with SEV secreted by WT-T47D, in presence or not of actinomycin and TGFß1 was measured by ELISA (n=2; *p<0.05). (B) Highly invasive MDA-MB-231, transiently transfected with a siRNA control or a siRNA directed against endogenous TGFb1, were pre-treated or not with SEV produced by low invasive WT-T47D breast cancer cell line and tested for their invasive capacity. In some cases MDA-MB-231 were treated with exogenous TGFb1 to reverse the effect of siRNA (n=2; *p<0.005).

FIG. 6. SEV produced by WT-T47D cells are competent in up-regulating the activity of the hTGFB1 promoter. (A) Schematic representation of the hTGFb1 promoter. Six potential NFAT-binding sites have been found using the NFAT binding site they have developed at the address: software: http://www.fast-db.com/perl/nfat.pl; positions relative to the +1 initiation site are indicated. (B) SUM-159-PT cells were cotransfected with the pCS4-(n)-b-galactosidase and the hTGFb1 promoter plasmids or the pGL3 basic vector as a control and left untreated or treated with SEV from WT-T47D. After 24 h, cells were analysed for Luciferase and b-galactosidase activities. Quantification of hTGFb1 promoter-mediated Luciferase activity was normalized relative to that of the b-galactosidase and compare to the control luciferase activity of the pGL3 basic vector. (n=2; *p<0.005).

FIG. 7. Intra-venous injection of SEV produced by low invasive breast cancer cell line inhibit tumor growth and metastases apparition and correlate with an induction of TGFb1. (A) 1.10⁶ MDA-MB-231 cells (D3H2LN) in 100 ml PBS were injected into the left Fat Pad of each 6-week-old female mouse Athymic Nude-Foxn1nu mice. Tumor growth is presented as the mean tumor volume (cm3), with data from mice N° 629 (A and B) injected weekly intra-venous with PBS and data from mice N° 610 (A) or N° 625 (B) injected weekly intra-venous with 50.10⁸ pp SEV produced by WT T-47D 7 days after cell transplantation in the Fat Pad. Serum TGFb1 measurement in the blood is presented as ng/ml with data from mice N° 629 (A and B) injected weekly intra-venous with PBS and from mice N° 610 (A) or N° 625 (B) injected weekly intra-venous with 50.10⁸ pp SEV produced by WT T47D. (C and D) Beginning day 42, weekly, bioluminescent images (where the primary tumor was shield with a black tissue) were acquired on the Xenogen system to quantify the mean photon flux produced by the metastatic MDA-MB-231 cells. Metastases quantification is presented as the mean photon flux produced by the metastatic MDA-MB-231 cells, with data from mice N° 629 (C and D) injected weekly intra-venous with PBS and data from mice N° 610 (C) or N° 625 (D) injected weekly with 50.10⁸ pp SEV intra-venous produced by WT T47D. TGFb1 measurement in the blood is presented as ng/ml, with data from mice N° 629 (A and B) injected weekly intra-venous with PBS and data from mice N° 610 (C) or N° 625 (D) injected weekly 50.10⁸ pp SEV intra-venous produced by WT T47D.

FIG. 8. Intra-tumor injection of SEV produced by low invasive breast cancer cell line inhibit tumor growth and metastases apparition and correlate with an induction of TGFb1. (A) 1.10⁶ MDA-MB-231 cells (D3H2LN) in 100 ml PBS were injected into the left Fat Pad of each 6-week-old female mouse Athymic Nude-Foxn1nu mice. Tumor growth is presented as the mean tumor volume (cm3), with data from mice N° 617 (A and B) injected weekly intratumoral with PBS and data from mice N° 614 (A) or N° 602 (B) injected weekly intratumoral with 50.10⁸ pp SEV produced by WT T-47D, 7 days after cell transplantation in the Fat Pad. Serum TGFb1 measurement in the blood is presented as ng/ml with data from mice N° 629 (A and B) injected weekly intratumoral with PBS and from mice N° 617 (A) or N° 602 (B) injected weekly intra-venous with 50.10⁸ pp SEV produced by WT T47D. (C and D) Beginning day 42, weekly, bioluminescent images (where the primary tumor was shield with a black tissue) were acquired on the Xenogen system to quantify the mean photon flux produced by the metastatic MDA-MB-231 cells. Metastases quantification is presented as the mean photon flux produced by the metastatic MDA-MB-231 cells, with data from mice N° 617 (C and D) injected weekly intratumoral with PBS and data from mice N° 614 (C) or N° 602 (D) injected weekly with 50.10⁸ pp SEV intratumoral produced by WT T47D. TGFb1 measurement in the blood is presented as ng/ml, with data from mice N° 617 (A and B) injected weekly intratumoral with PBS and data from mice N° 614 (C) or N° 602 (D) injected weekly 50.10⁸ pp SEV intratumoral produced by WT T47D.

FIG. 9. The inhibitory effect on the tumor growth of the intratumoral injection of SEV requires the expression of NFAT3 in the T47D-SEV producing cells and correlates with induction of TGFb1. 1.10⁶ MDA-MB-231 cells (D3H2LN) in 100 ml PBS were injected into the left Fat Pad of each 6-week-old female mouse Athymic Nude-Foxn1nu mice. (A) Tumor growth is presented as the mean tumor volume (cm3)±SEM, from mice injected weekly intratumoral with PBS (PBS), from mice injected weekly intratumoral with 50.10⁸ pp SEV produced by shCtrl-infected T47D cells (50.10⁸ T47D-shCtrl intratumoral), from mice injected weekly intratumoral with 50.10⁸ pp SEV produced by shNFAT3-4-infected T47D cells (50.10⁸ T47D-shNFAT3-4 intratumoral), from mice injected weekly intratumoral with 50.10⁸ pp SEV produced by shNFAT3-3-infected T47D cells, 7 days after cell transplantation in the Fat Pad, 8 mice in each group. Comparisons were made using a two-tailed, unpaired Student's t test for each time point with the mice injected with PBS intratumoral. (B) Beginning day 42, weekly, bioluminescent images (where the primary tumor was shield with a black tissue) were acquired on the Xenogen system to quantify the mean photon flux produced by the metastatic MDA-MB-231 cells. Metastases quantification is presented as the mean photon flux produced by the metastatic MDA-MB-231 cells, with data from mice injected weekly intra-venous with PBS or 50.10⁸ pp SEV T47D-shCtrl intratumoral or 50.10⁸ pp SEV T47D-shNFAT3-4 intratumoral or 50.10⁸pp SEV produced by 50.10⁸ pp SEV shNFAT3-3-infected T47D cells. *p<0.05 **p<0.005 and ***p<0.0005. (C) and (D) Serum was collected weekly from the mice of group (A) and concentration of TGFb1 present in the serum was evaluated by ELISA assay at the end of the experiment. (C) each point for each group represents the 60 days mean of TGFb1 concentration in the serum from week 1 to 9. Comparisons were made using a two-tailed, unpaired Student's t test for each time point with the mice injected with PBS intratumoral. *p<0.05. (D) data are represented for each group of mice as in (A) from week 1 to 9.

FIG. 10.: Delayed injection of SEV produced by T47D cell inhibit tumor growth. 0.5.10⁶ MDA-MB-231 cells (D3H2LN) in 100 ml PBS were injected into the left Fad Pad of each 6-week-old female Athymic Nude-Foxn1nu mouse. (A) Tumor growth is presented as the mean tumor volume (cm3)+/−SEM, from mice injected weekly, beginning day 27 intra-venous with PBS (PBS), from mice injected weekly, beginning day 27, intra-venous with 50.10⁸ ppSEV produced by T47D-WT cells. (B) Tumor growth is presented as the mean tumor volume (cm3)+/−SEM, from mice injected weekly, beginning day 27 intra-tumor with PBS (PBS), from mice injected weekly, beginning day 27, intratumoral with 50.10⁸ ppSEV produced by T47D-WT cells. Comparisons were made using a two-tailed, unpaired student's test for each time point. *p<0.05, **p<0.005, ***p<0.0005. (8 mice/group).

FIG. 11. Schematic diagram of the proposed therapy development.

FIG. 12. NFAT3 is expressed in HEK cells as in T47D cells. T47D cells and HEK cell were transiently transfected with either a non-targeting siRNA control (siCtl) or a siRNA targeting endogenous NFAT3 (siNFAT3). 48 h after transfection, whole cells lysate were probed for endogenous NFAT3 with an antibody directed against NFAT3. Control of equal loading was evaluated by probing the membrane with an antibody directed against Actin.

FIG. 13. Generation of NFAT3-expressing HEK cells. (A) Representation of the NFAT3 constructs used to infect HEK cells fused with the tdTomato tag. (B) T47D breast cancer cells were transiently transfected with either the vector control of NFAT3 WT, ΔNFAT3 or NFAT3 lacking the last 85 C-terminal amino acids and assess for their invasive capacity in classical transwell invasion assay. (C) Expressions the different NFAT3 constructs in the HEK-producing SEV were evaluated by western blot with the indicated antibodies.

FIG. 14. Characterization by size and specific markers of SEV produced by HEK cells. Representative examples of size distribution of SEV produced by HEK to-Ctl (A), HEK to-NFAT3 (B). HEK to-ΔNFAT3 (C) and HEK to-NFAT3-85C (D), evaluated by the NanoSight. SEV concentration (particles/ml:pp/mL) is shown in function of particle size (nm).

FIG. 15. Exosomes produced by NFAT3 expressing HEK cells inhibit invasion of highly invasive MDA-MB-231 cells. (A) Highly invasive breast cancer cells (MDA-MB-231) were pre-treated or not with exosomes produced by either low invasive T47D breast cancer cell line WT or HEK human embryonic cell line stably expressing either to-NFAT3 or to-ΔNFAT3 or to-NFAT3-85C) and as a control the empty vector (to-Ctl) and tested for their invasive capacity. *p<0.05 **p<0.005 and ***p<0.0005, compared to the untreated cells (−). (n=2). (B) Highly invasive breast cancer cells (SUM-159-PT) were pre-treated or not with exosomes produced by either low invasive T47D breast cancer cell line WT or HEK human embryonic cell line stably expressing either to-NFAT3 or to-ΔNFAT3 or to-NFAT3-85C) and as a control the empty vector (to-Ctl) and tested for their invasive capacity. *p<0.05 **p<0.005 and ***p<0.0005, compared to the untreated cells (−). (n=2) (C) Highly invasive pancreatic cancer cells (BXPC3) were pre-treated or not with exosomes produced by either low invasive T47D breast cancer cell line WT or HEK human embryonic cell line stably expressing either to-NFAT3 or to-ΔNFAT3 or to-NFAT3-85C) and as a control the empty vector (to-Ctl) and tested for their invasive capacity. *p<0.05 **p<0.005 and ***p<0.0005, compared to the untreated cells (−). (n=2) (D) Highly invasive glioblastoma cancer cells (U87MG) were pre-treated or not with exosomes produced by either low invasive T47D breast cancer cell line WT or HEK human embryonic cell line stably expressing either to-NFAT3 or to-ΔNFAT3 or to-NFAT3-85C) and as a control the empty vector (to-Ctl) and tested for their invasive capacity. *p<0.05 **p<0.005 and ***p<0.0005, compared to the untreated cells (−). (n=2).

DETAILED DESCRIPTION OF THE INVENTION

Treatment of Cancer or Treatment or Prevention of Metastatic Cancer with a Composition Comprising Secreted Extracellular Vesicles (SEV) of Cells Expressing NFATC4

In a first aspect, the present invention relates to a composition, in particular a pharmaceutical composition comprising secreted extracellular vesicles (SEV) of cells expressing nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4 (NFATC4), for use in the treatment of cancer or in the treatment or prevention of metastatic cancer.

The present invention also relates to a method for treating cancer or for treating or preventing metastatic cancer in a patient in need thereof, comprising administering to said patient a therapeutically efficient amount of a composition comprising SEV of cells expressing NFATC4.

The present invention also relates to the use of a composition comprising SEV of cells expressing NFATC4 for preparing a drug intended for the treatment of cancer or for the treatment or prevention of metastatic cancer.

The present invention also relates to the use of a composition comprising SEV of cells expressing NFATC4 for the treatment of cancer or for the treatment or prevention of metastatic cancer.

Secreted Extracellular Vesicles (SEV)

By “secreted extracellular vesicles” or “SEV”, it is meant membranous vesicles released by cells in their microenvironment from their plasma membrane. In the context of the present invention, SEV typically have a diameter lower or equal to about 500 nm, in particular between about 30 and about 500 nm, or between about 40 and about 500 nm, or between about 50 and about 500 nm. SEV are surrounded by a phospholipid membrane, which preferably contains relatively high levels of cholesterol, sphingomyelin, and ceramide and preferably also contains detergent-resistant membrane domains (lipid rafts).

The membrane proteins of SEV have the same orientation as the cell. SEV are generally characterized by the presence of Actin B, proteins involved in membrane transport and fusion (such as Rab, GTPases, annexins, and flotillin), components of the endosomal sorting complex required for transport (ESCRT) complex (such as Alix), tumor susceptibility gene 101 (TSG101), heat shock proteins (HSPs, such as HSPA8, HSP90AA1, HSC70 and HSC90), integrins (such as CD62L, CD62E or CD62P), and tetraspanins (in particular CD63, CD81, CD82, CD53, CD9, and/or CD37).

SEV may also contain RNAs, such as mRNAs and miRNAs.

SEV may be prepared from cells secreting them by various methods, the most common and most preferred of which is differential centrifugation. Methods that may be used for preparing SEV used in the present invention include, as disclosed in Yakimchuk, K. Materials and Methods, vol. 5, 2015:

Differential Centrifugation:

-   -   As explained above, this method is one of the most common         techniques and the preferred method in the present invention.     -   The method consists of several steps, preferably performed at         about 4° C., including at least the following three steps 1) to         3):     -   1) a low speed centrifugation to remove cells and cellular         debris,     -   2) a higher speed spin to eliminate larger vesicles (size over         100 nm), and finally     -   3) high speed centrifugation to pellet SEV.     -   In step 1), cells and cellular debris are removed using         centrifugal accelerations of about 1300 to 3500 RPM (rounds per         minute) for 5-30 minutes. Optionally, step 1) may include two         low speed centrifugations, the first at very low speed (for         instance about 1350 RPM) and the second at highest speed (for         instance 3500 RPM).     -   In particular, spinning at 1350 RPM for 10 minutes at about         4° C. followed by spinning at 3500 RPM for 20 minutes at about         4° C. may be used in step 1).     -   In step 2), larger vesicles (size over 100 nm) are eliminated         using centrifugal accelerations of about 10 000 RPM for 15-45         minutes. In particular, spinning at about 10,000 RPM for 30         minutes at about 4° C. may be used in step 2).     -   In step 3), which is preferably performed at least twice, SEV         are pelleted using centrifugal accelerations of about 40 000 RPM         (for 60-120 minutes. In particular, spinning at 40,000 RPM for         90 minutes at about 4° C. may be used in step 3).     -   A particularly preferred protocol is as described below:     -   a) Spin cultured cells at 1350 RPM for 10 minutes at 4° C. and         collect supernatant;     -   b) Spin collected supernatant at 3500 RPM for 20 minutes at         4° C. and collect supernatant;     -   c) Spin collected supernatant at 10,000 RPM for 30 minutes at         4° C. and collect supernatant;     -   d) Ultracentrifuge collected supernatant at 40,000 RPM for 90         minutes at 4° C. and collect the pellet;     -   e) Resuspend the pellet in cold PBS; and     -   f) Ultracentrifuge at 40,000 RPM for 90 minutes at 4° C. and         collect the pellet.

Density Gradient Centrifugation:

-   -   This approach combines ultracentrifugation with sucrose density         gradient.     -   More specifically, density gradient centrifugation is used to         separate SEV from non-vesicular particles, such as proteins and         protein/RNA aggregates. Thus, this method separates vesicles         from the particles of different densities. The adequate         centrifugation time is very important, otherwise contaminating         particles may be still found in SEV fractions if they possess         similar densities. Recent studies suggest application of the SEV         pellet from ultracentrifugation to the sucrose gradient before         performing centrifugation.

Size Exclusion Chromatography:

-   -   Size-exclusion chromatography is used to separate macromolecules         on the base of size, not molecular weight. The technique applies         a column packed with porous polymeric beads containing multiple         pores and tunnels. The molecules pass through the beads         depending on their diameter. It takes longer time for molecules         with small radii to migrate through pores of the column, while         macromolecules elute earlier from the column. Size-exclusion         chromatography allows precise separation of large and small         molecules. Moreover, different eluting solutions can be applied         to this method.

Filtration:

-   -   Ultrafiltration membranes can also be used for isolation of SEV.         Depending on the size of microvesicles, this method allows the         separation of SEV from proteins and other macromolecules. SEV         may also be isolated by trapping them via a porous structure         (FIG. 2). Most common filtration membranes have pore sizes of         0.8 μm, 0.45 μm or 0.22 μm and can be used to collect SEV larger         than 800 nm, 400 nm or 200 nm. In particular, a micropillar         porous silicon ciliated structure was designed to isolate 40-100         nm SEV. During the initial step, the larger vesicles are         removed. In the following step, the SEV population is         concentrated on the filtration membrane. The isolation step is         relatively short, but the method requires pre-incubation of the         silicon structure with PBS buffer. In the following step, the         SEV population is concentrated on the filtration membrane.

Polymer-Based Precipitation:

-   -   Polymer-based precipitation technique usually includes mixing         the biological fluid with polymer-containing precipitation         solution, incubation at 4° C. and centrifugation at low speed.         One of the most common polymers used for polymer-based         precipitation is polyethylene glycol (PEG). The precipitation         with this polymer has a number of advantages, including mild         effects on isolated SEV and usage of neutral pH. Several         commercial kits applying PEG for isolation of SEV were         generated. The most commonly used kit is ExoQuick™ (System         Biosciences, Mountain View, Calif., USA). This kit is easy and         fast to perform and there is no need for additional equipment.         Recent studies demonstrated that the highest yield of SEV was         obtained using ultracentrifugation with ExoQuick™ method.

Immunological Separation:

-   -   Several techniques of immunological separation of SEV have been         developed, based on surface SEV receptors or SEV intracellular         proteins. These methods are however generally applied mainly for         detection, analysis and quantification of SEV proteins.

Isolation by Sieving:

-   -   This technique isolates SEV by sieving them from biological         liquids via a membrane and performing filtration by pressure or         electrophoresis.

NFATC4

“Nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4” or “NFATC4” as used herein refers to a protein encoded by the human gene with the official symbol NFATC4 in Entrez Gene database. (Gene ID: 4776) or variants thereof as defined below. The NFATC4 gene is also known as “nuclear factor of activated T-cells, cytoplasmic 4”, “T-cell transcription factor NFAT3”, “NFAT3”, “NF-AT3”, and “NF-ATC4”. The gene encodes several mRNA and protein isoforms, all of which are included in the definition of NFATC4 in the context of the present invention. The cDNA and protein sequences of various isoforms of NFATC4 are mentioned in Table 1 below:

TABLE 1 cDNA and protein sequences of human NFATC4 isoforms 1 to 7. Isoform 1 (This variant (1) represents the longest transcript and encodes isoform (1)) cDNA GTAAACGTCTGACCTGGGGCCGTCGCTTAACCGTTTAGTTGCTGGGATGGGGCGGCGTTGGGGG TGCGGCCCTGAACCGGAGGGATTTAGAGACTGGAGACGCGGCCTCTAAGAGAGGTTGAAACTGT GTGTGTGTGGGAGAAAATGATAACCACCCTCCCATCTCTCCTACCCGCCAGCCTCGCCAGTATCT CCCACCGAGTCACGAATCTCCCATCTAACTCCCTCTCACACAACCCAGGCCTCTCCAAGCCTGACT TTCCCGGAAACTCCAGTCCAGGTCTTCCTTCCTCCTCCAGCCCAGGCCGGGACCTGGGGGCTCCT GCCGGATCCATGGGGGCGGCCAGCTGCGAGGATGAGGAGCTGGAATTTAAGCTGGTGTTCGGG GAGGAAAAGGAGGCCCCCCCGCTGGGCGCGGGGGGATTGGGGGAAGAACTGGACTCAGAGGAT GCCCCGCCATGCTGCCGTCTGGCCTTGGGAGAGCCCCCTCCCTATGGCGCTGCACCTATCGGTAT TCCCCGACCTCCACCCCCTCGGCCTGGCATGCATTCGCCACCGCCGCGACCAGCCCCCTCACCTG GCACCTGGGAGAGCCAGCCCGCCAGGTCGGTGAGGCTGGGAGGACCAGGAGGGGGTGCTGGGG GTGCTGGGGGTGGCCGTGTTCTCGAGTGTCCCAGCATCCGCATCACCTCCATCTCTCCCACGCCG GAGCCGCCAGCAGCGCTGGAGGACAACCCTGATGCCTGGGGGGACGGCTCTCCTAGAGATTACC CCCCACCAGAAGGCTTTGGGGGCTACAGAGAAGCAGGGGGCCAGGGTGGGGGGGCCTTCTTCA GCCCAAGCCCTGGCAGCAGCAGCCTGTCCTCGTGGAGCTTCTTCTCCGATGCCTCTGACGAGGCA GCCCTGTATGCAGCCTGCGACGAGGTGGAGTCTGAGCTAAATGAGGCGGCCTCCCGCTTTGGCC TGGGCTCCCCGCTGCCCTCGCCCCGGGCCTCCCCTCGGCCATGGACCCCCGAAGATCCCTGGAGC CTGTATGGTCCAAGCCCCGGAGGCCGAGGGCCAGAGGATAGCTGGCTACTCCTCAGTGCTCCTG GGCCCACCCCAGCCTCCCCGCGGCCTGCCTCTCCATGTGGCAAGCGGCGCTATTCCAGCTCGGGA ACCCCATCTTCAGCCTCCCCAGCTCTGTCCCGCCGTGGCAGCCTGGGGGAAGAGGGGTCTGAGC CACCTCCACCACCCCCATTGCCTCTGGCCCGGGACCCGGGCTCCCCTGGTCCCTTTGACTATGTG GGGGCCCCACCAGCTGAGAGCATCCCTCAGAAGACACGGCGGACTTCCAGCGAGCAGGCAGTGG CTCTGCCTCGGTCTGAGGAGCCTGCCTCATGCAATGGGAAGCTGCCCTTGGGAGCAGAGGAGTC TGTGGCTCCTCCAGGAGGTTCCCGGAAGGAGGTGGCTGGCATGGACTACCTGGCAGTGCCCTCC CCACTCGCTTGGTCCAAGGCCCGGATTGGGGGACACAGCCCTATCTTCAGGACCTCTGCCCTACC CCCACTGGACTGGCCTCTGCCCAGCCAATATGAGCAGCTGGAGCTGAGGATCGAGGTACAGCCTA GAGCCCACCACCGGGCCCACTATGAGACAGAAGGCAGCCGTGGAGCTGTCAAAGCTGCCCCTGG CGGTCACCCCGTAGTCAAGCTCCTAGGCTACAGTGAGAAGCCACTGACCCTACAGATGTTCATCG GCACTGCAGATGAAAGGAACCTGCGGCCTCATGCCTTCTATCAGGTGCACCGTATCACAGGCAAG ATGGTGGCCACGGCCAGCTATGAAGCCGTAGTCAGTGGCACCAAGGTGTTGGAGATGACTCTGC TGCCTGAGAACAACATGGCGGCCAACATTGACTGCGCGGGAATCCTGAAGCTTCGGAATTCAGAC ATTGAGCTTCGGAAGGGTGAGACGGACATCGGGCGCAAAAACACACGTGTACGGCTGGTGTTCC GGGTACACGTGCCCCAGGGCGGCGGGAAGGTCGTCTCAGTACAGGCAGCATCGGTGCCCATCGA GTGCTCCCAGCGCTCAGCCCAGGAGCTGCCCCAGGTGGAGGCCTACAGCCCCAGTGCCTGCTCT GTGAGAGGAGGCGAGGAACTGGTACTGACTGGCTCCAACTTCCTGCCAGACTCCAAGGTGGTGT TCATTGAGAGGGGTCCTGATGGGAAGCTGCAATGGGAGGAGGAGGCCACAGTGAACCGACTGCA GAGCAACGAGGTGACGCTGACCCTGACTGTCCCCGAGTACAGCAACAAGAGGGTTTCCCGGCCA GTCCAGGTCTACTTTTATGTCTCCAATGGGCGGAGGAAACGCAGTCCTACCCAGAGTTTCAGGTT TCTGCCTGTGATCTGCAAAGAGGAGCCCCTACCGGACTCATCTCTGCGGGGTTTCCCTTCAGCAT CGGCAACCCCCTTTGGCACTGACATGGACTTCTCACCACCCAGGCCCCCCTACCCCTCCTATCCCC ATGAAGACCCTGCTTGCGAAACTCCTTACCTATCAGAAGGCTTCGGCTATGGCATGCCCCCTCTG TACCCCCAGACGGGGCCCCCACCATCCTACAGACCGGGCCTGCGGATGTTCCCTGAGACTAGGG GTACCACAGGTTGTGCCCAACCACCTGCAGTTTCCTTCCTTCCCCGCCCCTTCCCTAGTGACCCGT ATGGAGGGCGGGGCTCCTCTTTCTCCCTGGGGCTGCCATTCTCTCCGCCAGCCCCCTTTCGGCCG CCTCCTCTTCCTGCATCCCCACCGCTTGAAGGCCCCTTCCCTTCCCAGAGTGATGTGCATCCCCTA CCTGCTGAGGGATACAATAAGGTAGGGCCAGGCTATGGCCCTGGGGAGGGGGCTCCGGAGCAG GAGAAATCCAGGGGTGGCTACAGCAGCGGCTTCCGAGACAGTGTCCCTATCCAGGGTATCACGC TGGAGGAAGGTGGGTGTGGGACTGGGGGCTGTGAGTGTGAGTGTGTGCAAGAGATTGCTCTGC ATGTTTGCTGAGGGCTGGAGCTGGGCTTTTCAGAGATCGGGCATCCCTGGTCTCTCAGGGCCAG TTGGAGGTTCCCAGGAGGCATGTTCTTGATGCCTGTGGCTGCCTGAATCCAATTAACTGAATTCT GAAGAGTGCATGGGGTAACTGTCTCAGCCTTTCTCCTGTCTCTGCCTCTGTCCTCTGCTCCAAAT CATAAAATCTCAGAGCTAGAAGCACTTTCAAGATCATTCCATCCAGCGCATTCAATTTGCAAGTTT AGGCGTTGAGTTCCAGAGAGGGATGGTAGCTTGCTGAGGTCCCAGTCAAGCACACTTGCCATTG CCTCAGCTTTCCCCTAAACACGGTGTCTGTGGTCAGGGTTGGTGAGGAGGAGCTTTCCTGTTTTG CCTCTCCTTCTTCCCATTGGCTACACCCATCTCTGGCCCTGCTGATACCGATTCCCCTGACATTTC AGGCTAAGCCAGCAGGAAAGGGCTAGGACGGGTGCCTGGGAGCCCACATGGAGGGAGTTGGGC AAGATTTGATTCGGAGCAGGTGTCAAGACGTGTTGGGGAAACTGAGGCCCAGTGGAATAGAAGC CAGTAGAGGAGGAATCTAGAGGCCTCCTAGATTAAGACCTGCCTGGAATGGATTGGGGGTGGGT CTTTGGAAAAGGAGGGGACCCACCTCTAGCCCAGTCTCTCAACTGCCCCTCCTTTACAGTGAGTG AGATCATTGGCCGAGACCTGAGTGGCTTCCCTGCACCTCCTGGAGAAGAGCCTCCTGCCTGAACC ACGTGAACTGTCATCACCTGGCAACCCCAGCCCCAGCCTCAGCCCTGCCCCCTTTCCCTCCTTCCT GGAGTGGTGGCTACAGAAGCTTGGGGCCAACCCTGGCTCCTCTTTCCCCAGCTTCTGTCTGTCTC ACTGTCTTCCCTCCCCTCCCCCAGCTGAGGTGTGGCCCTCAGGCCTGGTGCTGCCTTGGAGGGCT GGGGGAAGGAGTGTGTGGAGGAGGGAGGAGGGTGAAGACTGAGGCTAGGTGCCAGAATGGACT GGAGTGAAGGCGTGTCTAGAGTGTGGGCTGGCTGTTGTGCTGGAAAGCTGGGGACAGGTTGAT GGTAATAAACTGCTCAATGACCAGTGCTTCAGGCTCCAGAGCTCTTTGGAGAGATGGGTTGGGG CAGCTTACTCCAGCCCTGGCCCAAGGAGGCCCAGAAGTTGGAAAGAGATGGAATGTGGCTGGGA ACATTGCATCCCAAAGAGCTTCTCAGTGGAGGAGGCTGGGGAAGGCATGAGGGGGCTCAGAGGC TCCTTGACTGGGACCAGGATTGGGGGCCAGGGCTTGAGTAGGCCTCTCCACTCTCCTCCTTGGG GGTCCAGATTCCTTAGGAGCTTTGGGATGAGGCCCAGGAGGCTGCATTTTTCCAGGTCCTTAGTC TTGCCACCACACAGATGATTCTGATTCATAGCCAAGATGAGGACACACTGATGTAGCTGATCTCTC ATTTACAGAGGAGGATTCTAAAGTTCAGAGAGGGAAAGGGGCTTGCCTGAGGTCACGTAGATAAT CAGCAGCACATTGAACGCTGCACTCCTGGGCTCCTGTCCCCAGCCCCCATTCAGACACGCTGACT CAGGAGGTCCAGGCCTCTAAGGCTTCTCTCCCTGGAGTGAGGGTGGAGGTGAGGGAGAGCTGG CACAAGCCCTCCCTCTGGATCCTCCACTCCTGGGGATTATGAAGATATTCTGGAAAGATTTGTGC TTCAGAGGTAGACTGCAGAAAGCAAACAGTCTACCCAGCAGCTCTGAATGTCACCTGCCCTGGGG CTTACAGCACTATATGAGTTCCTGGCCTATCCTGCAAATATGCCCATGCTGGCCTTCTAAATAGCT GGTACATCCATCACCACTGACGGGCCTGGCCTGGAAACCTGGTTTGTCCCCTGTCTTGATGGCCT ACGAGAGGCCAAGTTCCACTGGGCTGGGAAAAGTCACTTTGTCTGTCTTGTTCACCTGGAGCCTG ACACACCGTAGGTACTGAGTACAAATAGCTTGATTTGGCTAGGCTTGGCTGCAGGGGGACGTGC CTAAAAGACATTCCGGGCATTTGCACTTGGGAAACTTGCCTCACCTTCAGGCTTGTGGGGCCTCT CTATGCCCAATGAGTCCAGGCAGTCCTAGCAAGTACTCAGGAGAGCAGGGGTGGGTGTGACAGA GGCTGGCTCTGGATTGGGGGACAACAGAACCAGAGTAACTCCTCGCCTGTTGCTGCTTTGCAATG AATTTCCTTTACCTTTCTGGAACACAAGCTGCTGTGAACCAAACTGATATCAAGTGATTAGCTCAC CGGGCCTTGGTTGCTTTTCAAAGATCCCCTTCAGCCCCCTGCCAGAGTCACTGCCCCATAATCACC ATGTCAGAAGGGACCCTAGGGCATTCGTGTCCTATTTATCAATCTTCAGCACCACCTCTAAGATCT CTGAGAGAGGGTGGATCAGCCTCTGTGTAAACAAAAAGCTGTTAGGACTTGTTGCCTCTCAAGGT GGACTATTCTGTTTTCTGCCAGGACACTGCCATTCATGCATTGTCAGATATTTATTAAACAGCAGC AAAGTGCCAGCCAATTTGTCCTGGAGGAATTCATAGCCTCATGGGGCAAAAGTAAATAAACAGCT TATTACAATTCAACAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA (NCBI Reference Sequence: NM_001136022.2; SEQ ID NO: 1) Protein MITTLPSLLPASLASISHRVTNLPSNSLSHNPGLSKPDFPGNSSPGLPSSSSPGRDLGAPAGSMGAASCEDE ELEFKLVFGEEKEAPPLGAGGLGEELDSEDAPPCCRLALGEPPPYGAAPIGIPRPPPPRPGMHSPPPRPA PSPGTWESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWGDGSPRDYPP PEGFGGYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRFGLGSPLPSP RASPRPWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPSSASPALSRR GSLGEEGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPASCNGKLPLG AEESVAPPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLELRIEVQPRA HHRAHYETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRITGKMVATA SYEAVVSGTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHVPQGGGKV VSVQAASVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKLQWEEEAT VNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSLRGFPSASA TPFGTDMDFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPETRGTTGCA QPPAVSFLPRPFPSDPYGGRGSSFSLGLPFSPPAPFRPPPLPASPPLEGPFPSQSDVHPLPAEGYNKVGP GYGPGEGAPEQEKSRGGYSSGFRDSVPIQGITLEEGGCGTGGCECECVQEIALHVC (NCBI Reference Sequence: NP_001129494.1; SEQ ID NO: 2, 964 amino acids) Isoform 2 (This variant (2) is alternatively spliced at the 5′ and 3′ ends compared to transcript variant 1. This results in the use of an in-frame downstream AUG, translation termination at a downstream stop codon, and a shorter isoform (2) with a distinct C-terminus compared to isoform 1) cDNA GAAGAGAGGACAGAGGGAGGGAGGGTGGGGGAGGACGAGGGGCGCGTGGTTTTCCCATCTCAT CCCTGGAGGAGGGGCTGGAGCATCCCCGGCAGCCAATCAGGGACAGGCTGGGGGGGGGACCGC TTTGAAGAAGTTTGGGGGAAAAAAGTTTGGAAAAGTTTCTATAATAACGAGGGGGCTTCTGGAG GGAGGCGGCAGCGACGGAGGAGGGGGCTTCTCAGAGAAAGGGAGGGAGGGAGCCACCCGGGTG AAGATACAGCAGCCTCCTGAACTCCCCCCTCCCACCCAGGCCGGGACCTGGGGGCTCCTGCCGGA TCCATGGGGGCGGCCAGCTGCGAGGATGAGGAGCTGGAATTTAAGCTGGTGTTCGGGGAGGAA AAGGAGGCCCCCCCGCTGGGCGCGGGGGGATTGGGGGAAGAACTGGACTCAGAGGATGCCCCG CCATGCTGCCGTCTGGCCTTGGGAGAGCCCCCTCCCTATGGCGCTGCACCTATCGGTATTCCCCG ACCTCCACCCCCTCGGCCTGGCATGCATTCGCCACCGCCGCGACCAGCCCCCTCACCTGGCACCT GGGAGAGCCAGCCCGCCAGGTCGGTGAGGCTGGGAGGACCAGGAGGGGGTGCTGGGGGTGCT GGGGGTGGCCGTGTTCTCGAGTGTCCCAGCATCCGCATCACCTCCATCTCTCCCACGCCGGAGCC GCCAGCAGCGCTGGAGGACAACCCTGATGCCTGGGGGGACGGCTCTCCTAGAGATTACCCCCCA CCAGAAGGCTTTGGGGGCTACAGAGAAGCAGGGGGCCAGGGTGGGGGGGCCTTCTTCAGCCCA AGCCCTGGCAGCAGCAGCCTGTCCTCGTGGAGCTTCTTCTCCGATGCCTCTGACGAGGCAGCCCT GTATGCAGCCTGCGACGAGGTGGAGTCTGAGCTAAATGAGGCGGCCTCCCGCTTTGGCCTGGGC TCCCCGCTGCCCTCGCCCCGGGCCTCCCCTCGGCCATGGACCCCCGAAGATCCCTGGAGCCTGTA TGGTCCAAGCCCCGGAGGCCGAGGGCCAGAGGATAGCTGGCTACTCCTCAGTGCTCCTGGGCCC ACCCCAGCCTCCCCGCGGCCTGCCTCTCCATGTGGCAAGCGGCGCTATTCCAGCTCGGGAACCCC ATCTTCAGCCTCCCCAGCTCTGTCCCGCCGTGGCAGCCTGGGGGAAGAGGGGTCTGAGCCACCT CCACCACCCCCATTGCCTCTGGCCCGGGACCCGGGCTCCCCTGGTCCCTTTGACTATGTGGGGGC CCCACCAGCTGAGAGCATCCCTCAGAAGACACGGCGGACTTCCAGCGAGCAGGCAGTGGCTCTG CCTCGGTCTGAGGAGCCTGCCTCATGCAATGGGAAGCTGCCCTTGGGAGCAGAGGAGTCTGTGG CTCCTCCAGGAGGTTCCCGGAAGGAGGTGGCTGGCATGGACTACCTGGCAGTGCCCTCCCCACT CGCTTGGTCCAAGGCCCGGATTGGGGGACACAGCCCTATCTTCAGGACCTCTGCCCTACCCCCAC TGGACTGGCCTCTGCCCAGCCAATATGAGCAGCTGGAGCTGAGGATCGAGGTACAGCCTAGAGC CCACCACCGGGCCCACTATGAGACAGAAGGCAGCCGTGGAGCTGTCAAAGCTGCCCCTGGCGGT CACCCCGTAGTCAAGCTCCTAGGCTACAGTGAGAAGCCACTGACCCTACAGATGTTCATCGGCAC TGCAGATGAAAGGAACCTGCGGCCTCATGCCTTCTATCAGGTGCACCGTATCACAGGCAAGATGG TGGCCACGGCCAGCTATGAAGCCGTAGTCAGTGGCACCAAGGTGTTGGAGATGACTCTGCTGCC TGAGAACAACATGGCGGCCAACATTGACTGCGCGGGAATCCTGAAGCTTCGGAATTCAGACATTG AGCTTCGGAAGGGTGAGACGGACATCGGGCGCAAAAACACACGTGTACGGCTGGTGTTCCGGGT ACACGTGCCCCAGGGCGGCGGGAAGGTCGTCTCAGTACAGGCAGCATCGGTGCCCATCGAGTGC TCCCAGCGCTCAGCCCAGGAGCTGCCCCAGGTGGAGGCCTACAGCCCCAGTGCCTGCTCTGTGA GAGGAGGCGAGGAACTGGTACTGACTGGCTCCAACTTCCTGCCAGACTCCAAGGTGGTGTTCATT GAGAGGGGTCCTGATGGGAAGCTGCAATGGGAGGAGGAGGCCACAGTGAACCGACTGCAGAGC AACGAGGTGACGCTGACCCTGACTGTCCCCGAGTACAGCAACAAGAGGGTTTCCCGGCCAGTCCA GGTCTACTTTTATGTCTCCAATGGGCGGAGGAAACGCAGTCCTACCCAGAGTTTCAGGTTTCTGC CTGTGATCTGCAAAGAGGAGCCCCTACCGGACTCATCTCTGCGGGGTTTCCCTTCAGCATCGGCA ACCCCCTTTGGCACTGACATGGACTTCTCACCACCCAGGCCCCCCTACCCCTCCTATCCCCATGAA GACCCTGCTTGCGAAACTCCTTACCTATCAGAAGGCTTCGGCTATGGCATGCCCCCTCTGTACCC CCAGACGGGGCCCCCACCATCCTACAGACCGGGCCTGCGGATGTTCCCTGAGACTAGGGGTACC ACAGGTTGTGCCCAACCACCTGCAGTTTCCTTCCTTCCCCGCCCCTTCCCTAGTGACCCGTATGGA GGGCGGGGCTCCTCTTTCTCCCTGGGGCTGCCATTCTCTCCGCCAGCCCCCTTTCGGCCGCCTCC TCTTCCTGCATCCCCACCGCTTGAAGGCCCCTTCCCTTCCCAGAGTGATGTGCATCCCCTACCTGC TGAGGGATACAATAAGGTAGGGCCAGGCTATGGCCCTGGGGAGGGGGCTCCGGAGCAGGAGAA ATCCAGGGGTGGCTACAGCAGCGGCTTCCGAGACAGTGTCCCTATCCAGGGTATCACGCTGGAG GAAGTGAGTGAGATCATTGGCCGAGACCTGAGTGGCTTCCCTGCACCTCCTGGAGAAGAGCCTC CTGCCTGAACCACGTGAACTGTCATCACCTGGCAACCCCAGCCCCAGCCTCAGCCCTGCCCCCTTT CCCTCCTTCCTGGAGTGGTGGCTACAGAAGCTTGGGGCCAACCCTGGCTCCTCTTTCCCCAGCTT CTGTCTGTCTCACTGTCTTCCCTCCCCTCCCCCAGCTGAGGTGTGGCCCTCAGGCCTGGTGCTGC CTTGGAGGGCTGGGGGAAGGAGTGTGTGGAGGAGGGAGGAGGGTGAAGACTGAGGCTAGGTG CCAGAATGGACTGGAGTGAAGGCGTGTCTAGAGTGTGGGCTGGCTGTTGTGCTGGAAAGCTGG GGACAGGTTGATGGTAATAAACTGCTCAATGACCAGTGCTTCAGGCTCCAGAGCTCTTTGGAGAG ATGGGTTGGGGCAGCTTACTCCAGCCCTGGCCCAAGGAGGCCCAGAAGTTGGAAAGAGATGGAA TGTGGCTGGGAACATTGCATCCCAAAGAGCTTCTCAGTGGAGGAGGCTGGGGAAGGCATGAGGG GGCTCAGAGGCTCCTTGACTGGGACCAGGATTGGGGGCCAGGGCTTGAGTAGGCCTCTCCACTC TCCTCCTTGGGGGTCCAGATTCCTTAGGAGCTTTGGGATGAGGCCCAGGAGGCTGCATTTTTCCA GGTCCTTAGTCTTGCCACCACACAGATGATTCTGATTCATAGCCAAGATGAGGACACACTGATGT AGCTGATCTCTCATTTACAGAGGAGGATTCTAAAGTTCAGAGAGGGAAAGGGGCTTGCCTGAGG TCACGTAGATAATCAGCAGCACATTGAACGCTGCACTCCTGGGCTCCTGTCCCCAGCCCCCATTCA GACACGCTGACTCAGGAGGTCCAGGCCTCTAAGGCTTCTCTCCCTGGAGTGAGGGTGGAGGTGA GGGAGAGCTGGCACAAGCCCTCCCTCTGGATCCTCCACTCCTGGGGATTATGAAGATATTCTGGA AAGATTTGTGCTTCAGAGGTAGACTGCAGAAAGCAAACAGTCTACCCAGCAGCTCTGAATGTCAC CTGCCCTGGGGCTTACAGCACTATATGAGTTCCTGGCCTATCCTGCAAATATGCCCATGCTGGCC TTCTAAATAGCTGGTACATCCATCACCACTGACGGGCCTGGCCTGGAAACCTGGTTTGTCCCCTG TCTTGATGGCCTACGAGAGGCCAAGTTCCACTGGGCTGGGAAAAGTCACTTTGTCTGTCTTGTTC ACCTGGAGCCTGACACACCGTAGGTACTGAGTACAAATAGCTTGATTTGGCTAGGCTTGGCTGCA GGGGGACGTGCCTAAAAGACATTCCGGGCATTTGCACTTGGGAAACTTGCCTCACCTTCAGGCTT GTGGGGCCTCTCTATGCCCAATGAGTCCAGGCAGTCCTAGCAAGTACTCAGGAGAGCAGGGGTG GGTGTGACAGAGGCTGGCTCTGGATTGGGGGACAACAGAACCAGAGTAACTCCTCGCCTGTTGC TGCTTTGCAATGAATTTCCTTTACCTTTCTGGAACACAAGCTGCTGTGAACCAAACTGATATCAAG TGATTAGCTCACCGGGCCTTGGTTGCTTTTCAAAGATCCCCTTCAGCCCCCTGCCAGAGTCACTG CCCCATAATCACCATGTCAGAAGGGACCCTAGGGCATTCGTGTCCTATTTATCAATCTTCAGCACC ACCTCTAAGATCTCTGAGAGAGGGTGGATCAGCCTCTGTGTAAACAAAAAGCTGTTAGGACTTGT TGCCTCTCAAGGTGGACTATTCTGTTTTCTGCCAGGACACTGCCATTCATGCATTGTCAGATATTT ATTAAACAGCAGCAAAGTGCCAGCCAATTTGTCCTGGAGGAATTCATAGCCTCATGGGGCAAAAG TAAATAAACAGCTTATTACAATTCAACAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAA (NCBI Reference Sequence: NM_004554.4; SEQ ID NO: 3) Protein MGAASCEDEELEFKLVFGEEKEAPPLGAGGLGEELDSEDAPPCCRLALGEPPPYGAAPIGIPRPPPPRPG MHSPPPRPAPSPGTWESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWG DGSPRDYPPPEGFGGYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRF GLGSPLPSPRASPRPWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPS SASPALSRRGSLGEEGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPAS CNGKLPLGAEESVAPPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLEL RIEVQPRAHHRAHYETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRIT GKMVATASYEAVVSGTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHV PQGGGKVVSVQAASVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKL QWEEEATVNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSL RGFPSASATPFGTDMDFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPE TRGTTGCAQPPAVSFLPRPFPSDPYGGRGSSFSLGLPFSPPAPFRPPPLPASPPLEGPFPSQSDVHPLPAE GYNKVGPGYGPGEGAPEQEKSRGGYSSGFRDSVPIQGITLEEVSEIIGRDLSGFPAPPGEEPPA (NCBI Reference Sequence: NP_004545.2; SEQ ID NO: 4, 902 amino acids) Isoform 3 (This variant (3) is alternatively spliced at the 5′ and 3′ ends compared to transcript variant 1. This results in the use of an in-frame downstream AUG, translation termination at a downstream stop codon, and a shorter isoform (3) with a distinct C-terminus compared to isoform 1) cDNA GAAGAGAGGACAGAGGGAGGGAGGGTGGGGGAGGACGAGGGGCGCGTGGTTTTCCCATCTCAT CCCTGGAGGAGGGGCTGGAGCATCCCCGGCAGCCAATCAGGGACAGGCTGGGGGGGGGACCGC TTTGAAGAAGTTTGGGGGAAAAAAGTTTGGAAAAGTTTCTATAATAACGAGGGGGCTTCTGGAG GGAGGCGGCAGCGACGGAGGAGGGGGCTTCTCAGAGAAAGGGAGGGAGGGAGCCACCCGGGTG AAGATACAGCAGCCTCCTGAACTCCCCCCTCCCACCCAGGCCGGGACCTGGGGGCTCCTGCCGGA TCCATGGGGGCGGCCAGCTGCGAGGATGAGGAGCTGGAATTTAAGCTGGTGTTCGGGGAGGAA AAGGAGGCCCCCCCGCTGGGCGCGGGGGGATTGGGGGAAGAACTGGACTCAGAGGATGCCCCG CCATGCTGCCGTCTGGCCTTGGGAGAGCCCCCTCCCTATGGCGCTGCACCTATCGGTATTCCCCG ACCTCCACCCCCTCGGCCTGGCATGCATTCGCCACCGCCGCGACCAGCCCCCTCACCTGGCACCT GGGAGAGCCAGCCCGCCAGGTCGGTGAGGCTGGGAGGACCAGGAGGGGGTGCTGGGGGTGCT GGGGGTGGCCGTGTTCTCGAGTGTCCCAGCATCCGCATCACCTCCATCTCTCCCACGCCGGAGCC GCCAGCAGCGCTGGAGGACAACCCTGATGCCTGGGGGGACGGCTCTCCTAGAGATTACCCCCCA CCAGAAGGCTTTGGGGGCTACAGAGAAGCAGGGGGCCAGGGTGGGGGGGCCTTCTTCAGCCCA AGCCCTGGCAGCAGCAGCCTGTCCTCGTGGAGCTTCTTCTCCGATGCCTCTGACGAGGCAGCCCT GTATGCAGCCTGCGACGAGGTGGAGTCTGAGCTAAATGAGGCGGCCTCCCGCTTTGGCCTGGGC TCCCCGCTGCCCTCGCCCCGGGCCTCCCCTCGGCCATGGACCCCCGAAGATCCCTGGAGCCTGTA TGGTCCAAGCCCCGGAGGCCGAGGGCCAGAGGATAGCTGGCTACTCCTCAGTGCTCCTGGGCCC ACCCCAGCCTCCCCGCGGCCTGCCTCTCCATGTGGCAAGCGGCGCTATTCCAGCTCGGGAACCCC ATCTTCAGCCTCCCCAGCTCTGTCCCGCCGTGGCAGCCTGGGGGAAGAGGGGTCTGAGCCACCT CCACCACCCCCATTGCCTCTGGCCCGGGACCCGGGCTCCCCTGGTCCCTTTGACTATGTGGGGGC CCCACCAGCTGAGAGCATCCCTCAGAAGACACGGCGGACTTCCAGCGAGCAGGCAGTGGCTCTG CCTCGGTCTGAGGAGCCTGCCTCATGCAATGGGAAGCTGCCCTTGGGAGCAGAGGAGTCTGTGG CTCCTCCAGGAGGTTCCCGGAAGGAGGTGGCTGGCATGGACTACCTGGCAGTGCCCTCCCCACT CGCTTGGTCCAAGGCCCGGATTGGGGGACACAGCCCTATCTTCAGGACCTCTGCCCTACCCCCAC TGGACTGGCCTCTGCCCAGCCAATATGAGCAGCTGGAGCTGAGGATCGAGGTACAGCCTAGAGC CCACCACCGGGCCCACTATGAGACAGAAGGCAGCCGTGGAGCTGTCAAAGCTGCCCCTGGCGGT CACCCCGTAGTCAAGCTCCTAGGCTACAGTGAGAAGCCACTGACCCTACAGATGTTCATCGGCAC TGCAGATGAAAGGAACCTGCGGCCTCATGCCTTCTATCAGGTGCACCGTATCACAGGCAAGATGG TGGCCACGGCCAGCTATGAAGCCGTAGTCAGTGGCACCAAGGTGTTGGAGATGACTCTGCTGCC TGAGAACAACATGGCGGCCAACATTGACTGCGCGGGAATCCTGAAGCTTCGGAATTCAGACATTG AGCTTCGGAAGGGTGAGACGGACATCGGGCGCAAAAACACACGTGTACGGCTGGTGTTCCGGGT ACACGTGCCCCAGGGCGGCGGGAAGGTCGTCTCAGTACAGGCAGCATCGGTGCCCATCGAGTGC TCCCAGCGCTCAGCCCAGGAGCTGCCCCAGGTGGAGGCCTACAGCCCCAGTGCCTGCTCTGTGA GAGGAGGCGAGGAACTGGTACTGACTGGCTCCAACTTCCTGCCAGACTCCAAGGTGGTGTTCATT GAGAGGGGTCCTGATGGGAAGCTGCAATGGGAGGAGGAGGCCACAGTGAACCGACTGCAGAGC AACGAGGTGACGCTGACCCTGACTGTCCCCGAGTACAGCAACAAGAGGGTTTCCCGGCCAGTCCA GGTCTACTTTTATGTCTCCAATGGGCGGAGGAAACGCAGTCCTACCCAGAGTTTCAGGTTTCTGC CTGTGATCTGCAAAGAGGAGCCCCTACCGGACTCATCTCTGCGGGGTTTCCCTTCAGCATCGGCA ACCCCCTTTGGCACTGACATGGACTTCTCACCACCCAGGCCCCCCTACCCCTCCTATCCCCATGAA GACCCTGCTTGCGAAACTCCTTACCTATCAGAAGGCTTCGGCTATGGCATGCCCCCTCTGTACCC CCAGACGGGGCCCCCACCATCCTACAGACCGGGCCTGCGGATGTTCCCTGAGACTAGGGGTACC ACAGTGAGTGAGATCATTGGCCGAGACCTGAGTGGCTTCCCTGCACCTCCTGGAGAAGAGCCTCC TGCCTGAACCACGTGAACTGTCATCACCTGGCAACCCCAGCCCCAGCCTCAGCCCTGCCCCCTTTC CCTCCTTCCTGGAGTGGTGGCTACAGAAGCTTGGGGCCAACCCTGGCTCCTCTTTCCCCAGCTTC TGTCTGTCTCACTGTCTTCCCTCCCCTCCCCCAGCTGAGGTGTGGCCCTCAGGCCTGGTGCTGCC TTGGAGGGCTGGGGGAAGGAGTGTGTGGAGGAGGGAGGAGGGTGAAGACTGAGGCTAGGTGC CAGAATGGACTGGAGTGAAGGCGTGTCTAGAGTGTGGGCTGGCTGTTGTGCTGGAAAGCTGGG GACAGGTTGATGGTAATAAACTGCTCAATGACCAGTGCTTCAGGCTCCAGAGCTCTTTGGAGAGA TGGGTTGGGGCAGCTTACTCCAGCCCTGGCCCAAGGAGGCCCAGAAGTTGGAAAGAGATGGAAT GTGGCTGGGAACATTGCATCCCAAAGAGCTTCTCAGTGGAGGAGGCTGGGGAAGGCATGAGGGG GCTCAGAGGCTCCTTGACTGGGACCAGGATTGGGGGCCAGGGCTTGAGTAGGCCTCTCCACTCT CCTCCTTGGGGGTCCAGATTCCTTAGGAGCTTTGGGATGAGGCCCAGGAGGCTGCATTTTTCCA GGTCCTTAGTCTTGCCACCACACAGATGATTCTGATTCATAGCCAAGATGAGGACACACTGATGT AGCTGATCTCTCATTTACAGAGGAGGATTCTAAAGTTCAGAGAGGGAAAGGGGCTTGCCTGAGG TCACGTAGATAATCAGCAGCACATTGAACGCTGCACTCCTGGGCTCCTGTCCCCAGCCCCCATTCA GACACGCTGACTCAGGAGGTCCAGGCCTCTAAGGCTTCTCTCCCTGGAGTGAGGGTGGAGGTGA GGGAGAGCTGGCACAAGCCCTCCCTCTGGATCCTCCACTCCTGGGGATTATGAAGATATTCTGGA AAGATTTGTGCTTCAGAGGTAGACTGCAGAAAGCAAACAGTCTACCCAGCAGCTCTGAATGTCAC CTGCCCTGGGGCTTACAGCACTATATGAGTTCCTGGCCTATCCTGCAAATATGCCCATGCTGGCC TTCTAAATAGCTGGTACATCCATCACCACTGACGGGCCTGGCCTGGAAACCTGGTTTGTCCCCTG TCTTGATGGCCTACGAGAGGCCAAGTTCCACTGGGCTGGGAAAAGTCACTTTGTCTGTCTTGTTC ACCTGGAGCCTGACACACCGTAGGTACTGAGTACAAATAGCTTGATTTGGCTAGGCTTGGCTGCA GGGGGACGTGCCTAAAAGACATTCCGGGCATTTGCACTTGGGAAACTTGCCTCACCTTCAGGCTT GTGGGGCCTCTCTATGCCCAATGAGTCCAGGCAGTCCTAGCAAGTACTCAGGAGAGCAGGGGTG GGTGTGACAGAGGCTGGCTCTGGATTGGGGGACAACAGAACCAGAGTAACTCCTCGCCTGTTGC TGCTTTGCAATGAATTTCCTTTACCTTTCTGGAACACAAGCTGCTGTGAACCAAACTGATATCAAG TGATTAGCTCACCGGGCCTTGGTTGCTTTTCAAAGATCCCCTTCAGCCCCCTGCCAGAGTCACTG CCCCATAATCACCATGTCAGAAGGGACCCTAGGGCATTCGTGTCCTATTTATCAATCTTCAGCACC ACCTCTAAGATCTCTGAGAGAGGGTGGATCAGCCTCTGTGTAAACAAAAAGCTGTTAGGACTTGT TGCCTCTCAAGGTGGACTATTCTGTTTTCTGCCAGGACACTGCCATTCATGCATTGTCAGATATTT ATTAAACAGCAGCAAAGTGCCAGCCAATTTGTCCTGGAGGAATTCATAGCCTCATGGGGCAAAAG TAAATAAACAGCTTATTACAATTCAACAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAA (NCBI Reference Sequence: NM_001198965.1; SEQ ID NO: 5) Protein MGAASCEDEELEFKLVFGEEKEAPPLGAGGLGEELDSEDAPPCCRLALGEPPPYGAAPIGIPRPPPPRPG MHSPPPRPAPSPGTWESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWG DGSPRDYPPPEGFGGYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRF GLGSPLPSPRASPRPWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPS SASPALSRRGSLGEEGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPAS CNGKLPLGAEESVAPPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLEL RIEVQPRAHHRAHYETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRIT GKMVATASYEAVVSGTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHV PQGGGKVVSVQAASVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKL QWEEEATVNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSL RGFPSASATPFGTDMDFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPE TRGTTVSEIIGRDLSGFPAPPGEEPPA (NCBI Reference Sequence: NP_001185894.1; SEQ ID NO: 6, 794 amino acids) Isoform 4 (This variant (4) is alternatively spliced at the 5′ and 3′ ends compared to transcript variant 1. This results in the use of an in-frame downstream AUG, translation termination at a downstream stop codon, and a shorter isoform (4) with a distinct C-terminus compared to isoform 1) cDNA ACGGTTGCGATGGCAACTGGGGCTCCTGCCAGCGCCGTTTGGGGGTTTGGGAACCGCTGCTAAT TGGGTTCATGTAACTGGACTCAGAGGATGCCCCGCCATGCTGCCGTCTGGCCTTGGGAGAGCCC CCTCCCTATGGCGCTGCACCTATCGGTATTCCCCGACCTCCACCCCCTCGGCCTGGCATGCATTC GCCACCGCCGCGACCAGCCCCCTCACCTGGCACCTGGGAGAGCCAGCCCGCCAGGTCGGTGAGG CTGGGAGGACCAGGAGGGGGTGCTGGGGGTGCTGGGGGTGGCCGTGTTCTCGAGTGTCCCAGC ATCCGCATCACCTCCATCTCTCCCACGCCGGAGCCGCCAGCAGCGCTGGAGGACAACCCTGATGC CTGGGGGGACGGCTCTCCTAGAGATTACCCCCCACCAGAAGGCTTTGGGGGCTACAGAGAAGCA GGGGGCCAGGGTGGGGGGGCCTTCTTCAGCCCAAGCCCTGGCAGCAGCAGCCTGTCCTCGTGGA GCTTCTTCTCCGATGCCTCTGACGAGGCAGCCCTGTATGCAGCCTGCGACGAGGTGGAGTCTGA GCTAAATGAGGCGGCCTCCCGCTTTGGCCTGGGCTCCCCGCTGCCCTCGCCCCGGGCCTCCCCTC GGCCATGGACCCCCGAAGATCCCTGGAGCCTGTATGGTCCAAGCCCCGGAGGCCGAGGGCCAGA GGATAGCTGGCTACTCCTCAGTGCTCCTGGGCCCACCCCAGCCTCCCCGCGGCCTGCCTCTCCAT GTGGCAAGCGGCGCTATTCCAGCTCGGGAACCCCATCTTCAGCCTCCCCAGCTCTGTCCCGCCGT GGCAGCCTGGGGGAAGAGGGGTCTGAGCCACCTCCACCACCCCCATTGCCTCTGGCCCGGGACC CGGGCTCCCCTGGTCCCTTTGACTATGTGGGGGCCCCACCAGCTGAGAGCATCCCTCAGAAGACA CGGCGGACTTCCAGCGAGCAGGCAGTGGCTCTGCCTCGGTCTGAGGAGCCTGCCTCATGCAATG GGAAGCTGCCCTTGGGAGCAGAGGAGTCTGTGGCTCCTCCAGGAGGTTCCCGGAAGGAGGTGG CTGGCATGGACTACCTGGCAGTGCCCTCCCCACTCGCTTGGTCCAAGGCCCGGATTGGGGGACA CAGCCCTATCTTCAGGACCTCTGCCCTACCCCCACTGGACTGGCCTCTGCCCAGCCAATATGAGCA GCTGGAGCTGAGGATCGAGGTACAGCCTAGAGCCCACCACCGGGCCCACTATGAGACAGAAGGC AGCCGTGGAGCTGTCAAAGCTGCCCCTGGCGGTCACCCCGTAGTCAAGCTCCTAGGCTACAGTGA GAAGCCACTGACCCTACAGATGTTCATCGGCACTGCAGATGAAAGGAACCTGCGGCCTCATGCCT TCTATCAGGTGCACCGTATCACAGGCAAGATGGTGGCCACGGCCAGCTATGAAGCCGTAGTCAGT GGCACCAAGGTGTTGGAGATGACTCTGCTGCCTGAGAACAACATGGCGGCCAACATTGACTGCG CGGGAATCCTGAAGCTTCGGAATTCAGACATTGAGCTTCGGAAGGGTGAGACGGACATCGGGCG CAAAAACACACGTGTACGGCTGGTGTTCCGGGTACACGTGCCCCAGGGCGGCGGGAAGGTCGTC TCAGTACAGGCAGCATCGGTGCCCATCGAGTGCTCCCAGCGCTCAGCCCAGGAGCTGCCCCAGG TGGAGGCCTACAGCCCCAGTGCCTGCTCTGTGAGAGGAGGCGAGGAACTGGTACTGACTGGCTC CAACTTCCTGCCAGACTCCAAGGTGGTGTTCATTGAGAGGGGTCCTGATGGGAAGCTGCAATGG GAGGAGGAGGCCACAGTGAACCGACTGCAGAGCAACGAGGTGACGCTGACCCTGACTGTCCCCG AGTACAGCAACAAGAGGGTTTCCCGGCCAGTCCAGGTCTACTTTTATGTCTCCAATGGGCGGAGG AAACGCAGTCCTACCCAGAGTTTCAGGTTTCTGCCTGTGATCTGCAAAGAGGAGCCCCTACCGGA CTCATCTCTGCGGGGTTTCCCTTCAGCATCGGCAACCCCCTTTGGCACTGACATGGACTTCTCAC CACCCAGGCCCCCCTACCCCTCCTATCCCCATGAAGACCCTGCTTGCGAAACTCCTTACCTATCAG AAGGCTTCGGCTATGGCATGCCCCCTCTGTACCCCCAGACGGGGCCCCCACCATCCTACAGACCG GGCCTGCGGATGTTCCCTGAGACTAGGGGTACCACAGGTTGTGCCCAACCACCTGCAGTTTCCTT CCTTCCCCGCCCCTTCCCTAGTGACCCGTATGGAGGGCGGGGCTCCTCTTTCTCCCTGGGGCTGC CATTCTCTCCGCCAGCCCCCTTTCGGCCGCCTCCTCTTCCTGCATCCCCACCGCTTGAAGGCCCCT TCCCTTCCCAGAGTGATGTGCATCCCCTACCTGCTGAGGGATACAATAAGGTAGGGCCAGGCTAT GGCCCTGGGGAGGGGGCTCCGGAGCAGGAGAAATCCAGGGGTGGCTACAGCAGCGGCTTCCGA GACAGTGTCCCTATCCAGGGTATCACGCTGGAGGAAGTGAGTGAGATCATTGGCCGAGACCTGA GTGGCTTCCCTGCACCTCCTGGAGAAGAGCCTCCTGCCTGAACCACGTGAACTGTCATCACCTGG CAACCCCAGCCCCAGCCTCAGCCCTGCCCCCTTTCCCTCCTTCCTGGAGTGGTGGCTACAGAAGC TTGGGGCCAACCCTGGCTCCTCTTTCCCCAGCTTCTGTCTGTCTCACTGTCTTCCCTCCCCTCCCC CAGCTGAGGTGTGGCCCTCAGGCCTGGTGCTGCCTTGGAGGGCTGGGGGAAGGAGTGTGTGGA GGAGGGAGGAGGGTGAAGACTGAGGCTAGGTGCCAGAATGGACTGGAGTGAAGGCGTGTCTAG AGTGTGGGCTGGCTGTTGTGCTGGAAAGCTGGGGACAGGTTGATGGTAATAAACTGCTCAATGA CCAGTGCTTCAGGCTCCAGAGCTCTTTGGAGAGATGGGTTGGGGCAGCTTACTCCAGCCCTGGC CCAAGGAGGCCCAGAAGTTGGAAAGAGATGGAATGTGGCTGGGAACATTGCATCCCAAAGAGCT TCTCAGTGGAGGAGGCTGGGGAAGGCATGAGGGGGCTCAGAGGCTCCTTGACTGGGACCAGGA TTGGGGGCCAGGGCTTGAGTAGGCCTCTCCACTCTCCTCCTTGGGGGTCCAGATTCCTTAGGAG CTTTGGGATGAGGCCCAGGAGGCTGCATTTTTCCAGGTCCTTAGTCTTGCCACCACACAGATGAT TCTGATTCATAGCCAAGATGAGGACACACTGATGTAGCTGATCTCTCATTTACAGAGGAGGATTC TAAAGTTCAGAGAGGGAAAGGGGCTTGCCTGAGGTCACGTAGATAATCAGCAGCACATTGAACGC TGCACTCCTGGGCTCCTGTCCCCAGCCCCCATTCAGACACGCTGACTCAGGAGGTCCAGGCCTCT AAGGCTTCTCTCCCTGGAGTGAGGGTGGAGGTGAGGGAGAGCTGGCACAAGCCCTCCCTCTGGA TCCTCCACTCCTGGGGATTATGAAGATATTCTGGAAAGATTTGTGCTTCAGAGGTAGACTGCAGA AAGCAAACAGTCTACCCAGCAGCTCTGAATGTCACCTGCCCTGGGGCTTACAGCACTATATGAGT TCCTGGCCTATCCTGCAAATATGCCCATGCTGGCCTTCTAAATAGCTGGTACATCCATCACCACTG ACGGGCCTGGCCTGGAAACCTGGTTTGTCCCCTGTCTTGATGGCCTACGAGAGGCCAAGTTCCAC TGGGCTGGGAAAAGTCACTTTGTCTGTCTTGTTCACCTGGAGCCTGACACACCGTAGGTACTGAG TACAAATAGCTTGATTTGGCTAGGCTTGGCTGCAGGGGGACGTGCCTAAAAGACATTCCGGGCAT TTGCACTTGGGAAACTTGCCTCACCTTCAGGCTTGTGGGGCCTCTCTATGCCCAATGAGTCCAGG CAGTCCTAGCAAGTACTCAGGAGAGCAGGGGTGGGTGTGACAGAGGCTGGCTCTGGATTGGGG GACAACAGAACCAGAGTAACTCCTCGCCTGTTGCTGCTTTGCAATGAATTTCCTTTACCTTTCTGG AACACAAGCTGCTGTGAACCAAACTGATATCAAGTGATTAGCTCACCGGGCCTTGGTTGCTTTTC AAAGATCCCCTTCAGCCCCCTGCCAGAGTCACTGCCCCATAATCACCATGTCAGAAGGGACCCTAG GGCATTCGTGTCCTATTTATCAATCTTCAGCACCACCTCTAAGATCTCTGAGAGAGGGTGGATCA GCCTCTGTGTAAACAAAAAGCTGTTAGGACTTGTTGCCTCTCAAGGTGGACTATTCTGTTTTCTG CCAGGACACTGCCATTCATGCATTGTCAGATATTTATTAAACAGCAGCAAAGTGCCAGCCAATTTG TCCTGGAGGAATTCATAGCCTCATGGGGCAAAAGTAAATAAACAGCTTATTACAATTCAACAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA (NCBI Reference Sequence: NM_001198966.2; SEQ ID NO: 7) Protein MHSPPPRPAPSPGTWESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWG DGSPRDYPPPEGFGGYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRF GLGSPLPSPRASPRPWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPS SASPALSRRGSLGEEGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPAS CNGKLPLGAEESVAPPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLEL RIEVQPRAHHRAHYETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRIT GKMVATASYEAVVSGTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHV PQGGGKVVSVQAASVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKL QWEEEATVNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSL RGFPSASATPFGTDMDFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPE TRGTTGCAQPPAVSFLPRPFPSDPYGGRGSSFSLGLPFSPPAPFRPPPLPASPPLEGPFPSQSDVHPLPAE GYNKVGPGYGPGEGAPEQEKSRGGYSSGFRDSVPIQGITLEEVSEIIGRDLSGFPAPPGEEPPA (NCBI Reference Sequence: NP_001185895.1; SEQ ID NO: 8, 832 amino acids) Isoform 5 (This variant (5) is alternatively spliced at the 3′ end compared to transcript variant 1. This results in translation termination at a downstream stop codon, and a shorter isoform (5) with a distinct C-terminus compared to isoform 1.) cDNA GTAAACGTCTGACCTGGGGCCGTCGCTTAACCGTTTAGTTGCTGGGATGGGGCGGCGTTGGGGG TGCGGCCCTGAACCGGAGGGATTTAGAGACTGGAGACGCGGCCTCTAAGAGAGGTTGAAACTGT GTGTGTGTGGGAGAAAATGATAACCACCCTCCCATCTCTCCTACCCGCCAGCCTCGCCAGTATCT CCCACCGAGTCACGAATCTCCCATCTAACTCCCTCTCACACAACCCAGGCCTCTCCAAGCCTGACT TTCCCGGAAACTCCAGTCCAGGTCTTCCTTCCTCCTCCAGCCCAGGCCGGGACCTGGGGGCTCCT GCCGGATCCATGGGGGCGGCCAGCTGCGAGGATGAGGAGCTGGAATTTAAGCTGGTGTTCGGG GAGGAAAAGGAGGCCCCCCCGCTGGGCGCGGGGGGATTGGGGGAAGAACTGGACTCAGAGGAT GCCCCGCCATGCTGCCGTCTGGCCTTGGGAGAGCCCCCTCCCTATGGCGCTGCACCTATCGGTAT TCCCCGACCTCCACCCCCTCGGCCTGGCATGCATTCGCCACCGCCGCGACCAGCCCCCTCACCTG GCACCTGGGAGAGCCAGCCCGCCAGGTCGGTGAGGCTGGGAGGACCAGGAGGGGGTGCTGGGG GTGCTGGGGGTGGCCGTGTTCTCGAGTGTCCCAGCATCCGCATCACCTCCATCTCTCCCACGCCG GAGCCGCCAGCAGCGCTGGAGGACAACCCTGATGCCTGGGGGGACGGCTCTCCTAGAGATTACC CCCCACCAGAAGGCTTTGGGGGCTACAGAGAAGCAGGGGGCCAGGGTGGGGGGGCCTTCTTCA GCCCAAGCCCTGGCAGCAGCAGCCTGTCCTCGTGGAGCTTCTTCTCCGATGCCTCTGACGAGGCA GCCCTGTATGCAGCCTGCGACGAGGTGGAGTCTGAGCTAAATGAGGCGGCCTCCCGCTTTGGCC TGGGCTCCCCGCTGCCCTCGCCCCGGGCCTCCCCTCGGCCATGGACCCCCGAAGATCCCTGGAGC CTGTATGGTCCAAGCCCCGGAGGCCGAGGGCCAGAGGATAGCTGGCTACTCCTCAGTGCTCCTG GGCCCACCCCAGCCTCCCCGCGGCCTGCCTCTCCATGTGGCAAGCGGCGCTATTCCAGCTCGGGA ACCCCATCTTCAGCCTCCCCAGCTCTGTCCCGCCGTGGCAGCCTGGGGGAAGAGGGGTCTGAGC CACCTCCACCACCCCCATTGCCTCTGGCCCGGGACCCGGGCTCCCCTGGTCCCTTTGACTATGTG GGGGCCCCACCAGCTGAGAGCATCCCTCAGAAGACACGGCGGACTTCCAGCGAGCAGGCAGTGG CTCTGCCTCGGTCTGAGGAGCCTGCCTCATGCAATGGGAAGCTGCCCTTGGGAGCAGAGGAGTC TGTGGCTCCTCCAGGAGGTTCCCGGAAGGAGGTGGCTGGCATGGACTACCTGGCAGTGCCCTCC CCACTCGCTTGGTCCAAGGCCCGGATTGGGGGACACAGCCCTATCTTCAGGACCTCTGCCCTACC CCCACTGGACTGGCCTCTGCCCAGCCAATATGAGCAGCTGGAGCTGAGGATCGAGGTACAGCCTA GAGCCCACCACCGGGCCCACTATGAGACAGAAGGCAGCCGTGGAGCTGTCAAAGCTGCCCCTGG CGGTCACCCCGTAGTCAAGCTCCTAGGCTACAGTGAGAAGCCACTGACCCTACAGATGTTCATCG GCACTGCAGATGAAAGGAACCTGCGGCCTCATGCCTTCTATCAGGTGCACCGTATCACAGGCAAG ATGGTGGCCACGGCCAGCTATGAAGCCGTAGTCAGTGGCACCAAGGTGTTGGAGATGACTCTGC TGCCTGAGAACAACATGGCGGCCAACATTGACTGCGCGGGAATCCTGAAGCTTCGGAATTCAGAC ATTGAGCTTCGGAAGGGTGAGACGGACATCGGGCGCAAAAACACACGTGTACGGCTGGTGTTCC GGGTACACGTGCCCCAGGGCGGCGGGAAGGTCGTCTCAGTACAGGCAGCATCGGTGCCCATCGA GTGCTCCCAGCGCTCAGCCCAGGAGCTGCCCCAGGTGGAGGCCTACAGCCCCAGTGCCTGCTCT GTGAGAGGAGGCGAGGAACTGGTACTGACTGGCTCCAACTTCCTGCCAGACTCCAAGGTGGTGT TCATTGAGAGGGGTCCTGATGGGAAGCTGCAATGGGAGGAGGAGGCCACAGTGAACCGACTGCA GAGCAACGAGGTGACGCTGACCCTGACTGTCCCCGAGTACAGCAACAAGAGGGTTTCCCGGCCA GTCCAGGTCTACTTTTATGTCTCCAATGGGCGGAGGAAACGCAGTCCTACCCAGAGTTTCAGGTT TCTGCCTGTGATCTGCAAAGAGGAGCCCCTACCGGACTCATCTCTGCGGGGTTTCCCTTCAGCAT CGGCAACCCCCTTTGGCACTGACATGGACTTCTCACCACCCAGGCCCCCCTACCCCTCCTATCCCC ATGAAGACCCTGCTTGCGAAACTCCTTACCTATCAGAAGGCTTCGGCTATGGCATGCCCCCTCTG TACCCCCAGACGGGGCCCCCACCATCCTACAGACCGGGCCTGCGGATGTTCCCTGAGACTAGGG GTACCACAGTGAGTGAGATCATTGGCCGAGACCTGAGTGGCTTCCCTGCACCTCCTGGAGAAGA GCCTCCTGCCTGAACCACGTGAACTGTCATCACCTGGCAACCCCAGCCCCAGCCTCAGCCCTGCC CCCTTTCCCTCCTTCCTGGAGTGGTGGCTACAGAAGCTTGGGGCCAACCCTGGCTCCTCTTTCCC CAGCTTCTGTCTGTCTCACTGTCTTCCCTCCCCTCCCCCAGCTGAGGTGTGGCCCTCAGGCCTGG TGCTGCCTTGGAGGGCTGGGGGAAGGAGTGTGTGGAGGAGGGAGGAGGGTGAAGACTGAGGCT AGGTGCCAGAATGGACTGGAGTGAAGGCGTGTCTAGAGTGTGGGCTGGCTGTTGTGCTGGAAA GCTGGGGACAGGTTGATGGTAATAAACTGCTCAATGACCAGTGCTTCAGGCTCCAGAGCTCTTTG GAGAGATGGGTTGGGGCAGCTTACTCCAGCCCTGGCCCAAGGAGGCCCAGAAGTTGGAAAGAGA TGGAATGTGGCTGGGAACATTGCATCCCAAAGAGCTTCTCAGTGGAGGAGGCTGGGGAAGGCAT GAGGGGGCTCAGAGGCTCCTTGACTGGGACCAGGATTGGGGGCCAGGGCTTGAGTAGGCCTCT CCACTCTCCTCCTTGGGGGTCCAGATTCCTTAGGAGCTTTGGGATGAGGCCCAGGAGGCTGCATT TTTCCAGGTCCTTAGTCTTGCCACCACACAGATGATTCTGATTCATAGCCAAGATGAGGACACACT GATGTAGCTGATCTCTCATTTACAGAGGAGGATTCTAAAGTTCAGAGAGGGAAAGGGGCTTGCCT GAGGTCACGTAGATAATCAGCAGCACATTGAACGCTGCACTCCTGGGCTCCTGTCCCCAGCCCCC ATTCAGACACGCTGACTCAGGAGGTCCAGGCCTCTAAGGCTTCTCTCCCTGGAGTGAGGGTGGA GGTGAGGGAGAGCTGGCACAAGCCCTCCCTCTGGATCCTCCACTCCTGGGGATTATGAAGATATT CTGGAAAGATTTGTGCTTCAGAGGTAGACTGCAGAAAGCAAACAGTCTACCCAGCAGCTCTGAAT GTCACCTGCCCTGGGGCTTACAGCACTATATGAGTTCCTGGCCTATCCTGCAAATATGCCCATGC TGGCCTTCTAAATAGCTGGTACATCCATCACCACTGACGGGCCTGGCCTGGAAACCTGGTTTGTC CCCTGTCTTGATGGCCTACGAGAGGCCAAGTTCCACTGGGCTGGGAAAAGTCACTTTGTCTGTCT TGTTCACCTGGAGCCTGACACACCGTAGGTACTGAGTACAAATAGCTTGATTTGGCTAGGCTTGG CTGCAGGGGGACGTGCCTAAAAGACATTCCGGGCATTTGCACTTGGGAAACTTGCCTCACCTTCA GGCTTGTGGGGCCTCTCTATGCCCAATGAGTCCAGGCAGTCCTAGCAAGTACTCAGGAGAGCAG GGGTGGGTGTGACAGAGGCTGGCTCTGGATTGGGGGACAACAGAACCAGAGTAACTCCTCGCCT GTTGCTGCTTTGCAATGAATTTCCTTTACCTTTCTGGAACACAAGCTGCTGTGAACCAAACTGATA TCAAGTGATTAGCTCACCGGGCCTTGGTTGCTTTTCAAAGATCCCCTTCAGCCCCCTGCCAGAGT CACTGCCCCATAATCACCATGTCAGAAGGGACCCTAGGGCATTCGTGTCCTATTTATCAATCTTCA GCACCACCTCTAAGATCTCTGAGAGAGGGTGGATCAGCCTCTGTGTAAACAAAAAGCTGTTAGGA CTTGTTGCCTCTCAAGGTGGACTATTCTGTTTTCTGCCAGGACACTGCCATTCATGCATTGTCAGA TATTTATTAAACAGCAGCAAAGTGCCAGCCAATTTGTCCTGGAGGAATTCATAGCCTCATGGGGC AAAAGTAAATAAACAGCTTATTACAATTCAACAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAA (NCBI Reference Sequence: NM_001198967.2; SEQ ID NO: 9) Protein MITTLPSLLPASLASISHRVTNLPSNSLSHNPGLSKPDFPGNSSPGLPSSSSPGRDLGAPAGSMGAASCEDE ELEFKLVFGEEKEAPPLGAGGLGEELDSEDAPPCCRLALGEPPPYGAAPIGIPRPPPPRPGMHSPPPRPA PSPGTWESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWGDGSPRDYPP PEGFGGYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRFGLGSPLPSP RASPRPWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPSSASPALSRR GSLGEEGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPASCNGKLPLG AEESVAPPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLELRIEVQPRA HHRAHYETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRITGKMVATA SYEAVVSGTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHVPQGGGKV VSVQAASVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKLQWEEEAT VNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSLRGFPSASA TPFGTDMDFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPETRGTTVSEI IGRDLSGFPAPPGEEPPA (NCBI Reference Sequence: NP_001185896.1; SEQ ID NO: 10, 857 amino acids) Isoform 6 (This variant (6) lacks part of the 5′ coding region, contains an alternate 5′-terminal exon, and initiates translation from an alternate start codon, compared to variant 1. The encoded isoform (6) has a shorter and distinct N-terminus, compared to isoform 1) cDNA ATGTGTGAGTCGCCCCCAGTCCAGCCCAGTGCCTCAAGAAACACGCCTCCAGGCCCAGCCCCAGC TCCAGCCCCTCTGGACCCACCTCTCTCACCTTAAGACCCACTGGATCGGGTACCCTCGGTCCTAG GATCCAGGGGCCAGTGGGCAAAGGCCTGGCATGCCTGCTTCAATCTCCTCCATCTTCCCAGGTCC AACTCTGCTTTTGTCTTGTGGCTCAGAAGAACTGGACTCAGAGGATGCCCCGCCATGCTGCCGTC TGGCCTTGGGAGAGCCCCCTCCCTATGGCGCTGCACCTATCGGTATTCCCCGACCTCCACCCCCT CGGCCTGGCATGCATTCGCCACCGCCGCGACCAGCCCCCTCACCTGGCACCTGGGAGAGCCAGCC CGCCAGGTCGGTGAGGCTGGGAGGACCAGGAGGGGGTGCTGGGGGTGCTGGGGGTGGCCGTG TTCTCGAGTGTCCCAGCATCCGCATCACCTCCATCTCTCCCACGCCGGAGCCGCCAGCAGCGCTG GAGGACAACCCTGATGCCTGGGGGGACGGCTCTCCTAGAGATTACCCCCCACCAGAAGGCTTTG GGGGCTACAGAGAAGCAGGGGGCCAGGGTGGGGGGGCCTTCTTCAGCCCAAGCCCTGGCAGCA GCAGCCTGTCCTCGTGGAGCTTCTTCTCCGATGCCTCTGACGAGGCAGCCCTGTATGCAGCCTGC GACGAGGTGGAGTCTGAGCTAAATGAGGCGGCCTCCCGCTTTGGCCTGGGCTCCCCGCTGCCCT CGCCCCGGGCCTCCCCTCGGCCATGGACCCCCGAAGATCCCTGGAGCCTGTATGGTCCAAGCCCC GGAGGCCGAGGGCCAGAGGATAGCTGGCTACTCCTCAGTGCTCCTGGGCCCACCCCAGCCTCCC CGCGGCCTGCCTCTCCATGTGGCAAGCGGCGCTATTCCAGCTCGGGAACCCCATCTTCAGCCTCC CCAGCTCTGTCCCGCCGTGGCAGCCTGGGGGAAGAGGGGTCTGAGCCACCTCCACCACCCCCAT TGCCTCTGGCCCGGGACCCGGGCTCCCCTGGTCCCTTTGACTATGTGGGGGCCCCACCAGCTGA GAGCATCCCTCAGAAGACACGGCGGACTTCCAGCGAGCAGGCAGTGGCTCTGCCTCGGTCTGAG GAGCCTGCCTCATGCAATGGGAAGCTGCCCTTGGGAGCAGAGGAGTCTGTGGCTCCTCCAGGAG GTTCCCGGAAGGAGGTGGCTGGCATGGACTACCTGGCAGTGCCCTCCCCACTCGCTTGGTCCAA GGCCCGGATTGGGGGACACAGCCCTATCTTCAGGACCTCTGCCCTACCCCCACTGGACTGGCCTC TGCCCAGCCAATATGAGCAGCTGGAGCTGAGGATCGAGGTACAGCCTAGAGCCCACCACCGGGC CCACTATGAGACAGAAGGCAGCCGTGGAGCTGTCAAAGCTGCCCCTGGCGGTCACCCCGTAGTCA AGCTCCTAGGCTACAGTGAGAAGCCACTGACCCTACAGATGTTCATCGGCACTGCAGATGAAAGG AACCTGCGGCCTCATGCCTTCTATCAGGTGCACCGTATCACAGGCAAGATGGTGGCCACGGCCAG CTATGAAGCCGTAGTCAGTGGCACCAAGGTGTTGGAGATGACTCTGCTGCCTGAGAACAACATGG CGGCCAACATTGACTGCGCGGGAATCCTGAAGCTTCGGAATTCAGACATTGAGCTTCGGAAGGGT GAGACGGACATCGGGCGCAAAAACACACGTGTACGGCTGGTGTTCCGGGTACACGTGCCCCAGG GCGGCGGGAAGGTCGTCTCAGTACAGGCAGCATCGGTGCCCATCGAGTGCTCCCAGCGCTCAGC CCAGGAGCTGCCCCAGGTGGAGGCCTACAGCCCCAGTGCCTGCTCTGTGAGAGGAGGCGAGGAA CTGGTACTGACTGGCTCCAACTTCCTGCCAGACTCCAAGGTGGTGTTCATTGAGAGGGGTCCTGA TGGGAAGCTGCAATGGGAGGAGGAGGCCACAGTGAACCGACTGCAGAGCAACGAGGTGACGCTG ACCCTGACTGTCCCCGAGTACAGCAACAAGAGGGTTTCCCGGCCAGTCCAGGTCTACTTTTATGT CTCCAATGGGCGGAGGAAACGCAGTCCTACCCAGAGTTTCAGGTTTCTGCCTGTGATCTGCAAAG AGGAGCCCCTACCGGACTCATCTCTGCGGGGTTTCCCTTCAGCATCGGCAACCCCCTTTGGCACT GACATGGACTTCTCACCACCCAGGCCCCCCTACCCCTCCTATCCCCATGAAGACCCTGCTTGCGAA ACTCCTTACCTATCAGAAGGCTTCGGCTATGGCATGCCCCCTCTGTACCCCCAGACGGGGCCCCC ACCATCCTACAGACCGGGCCTGCGGATGTTCCCTGAGACTAGGGGTACCACAGGTTGTGCCCAAC CACCTGCAGTTTCCTTCCTTCCCCGCCCCTTCCCTAGTGACCCGTATGGAGGGCGGGGCTCCTCT TTCTCCCTGGGGCTGCCATTCTCTCCGCCAGCCCCCTTTCGGCCGCCTCCTCTTCCTGCATCCCCA CCGCTTGAAGGCCCCTTCCCTTCCCAGAGTGATGTGCATCCCCTACCTGCTGAGGGATACAATAA GGTAGGGCCAGGCTATGGCCCTGGGGAGGGGGCTCCGGAGCAGGAGAAATCCAGGGGTGGCTA CAGCAGCGGCTTCCGAGACAGTGTCCCTATCCAGGGTATCACGCTGGAGGAAGGTGGGTGTGGG ACTGGGGGCTGTGAGTGTGAGTGTGTGCAAGAGATTGCTCTGCATGTTTGCTGAGGGCTGGAGC TGGGCTTTTCAGAGATCGGGCATCCCTGGTCTCTCAGGGCCAGTTGGAGGTTCCCAGGAGGCAT GTTCTTGATGCCTGTGGCTGCCTGAATCCAATTAACTGAATTCTGAAGAGTGCATGGGGTAACTG TCTCAGCCTTTCTCCTGTCTCTGCCTCTGTCCTCTGCTCCAAATCATAAAATCTCAGAGCTAGAAG CACTTTCAAGATCATTCCATCCAGCGCATTCAATTTGCAAGTTTAGGCGTTGAGTTCCAGAGAGG GATGGTAGCTTGCTGAGGTCCCAGTCAAGCACACTTGCCATTGCCTCAGCTTTCCCCTAAACACG GTGTCTGTGGTCAGGGTTGGTGAGGAGGAGCTTTCCTGTTTTGCCTCTCCTTCTTCCCATTGGCT ACACCCATCTCTGGCCCTGCTGATACCGATTCCCCTGACATTTCAGGCTAAGCCAGCAGGAAAGG GCTAGGACGGGTGCCTGGGAGCCCACATGGAGGGAGTTGGGCAAGATTTGATTCGGAGCAGGT GTCAAGACGTGTTGGGGAAACTGAGGCCCAGTGGAATAGAAGCCAGTAGAGGAGGAATCTAGAG GCCTCCTAGATTAAGACCTGCCTGGAATGGATTGGGGGTGGGTCTTTGGAAAAGGAGGGGACCC ACCTCTAGCCCAGTCTCTCAACTGCCCCTCCTTTACAGTGAGTGAGATCATTGGCCGAGACCTGA GTGGCTTCCCTGCACCTCCTGGAGAAGAGCCTCCTGCCTGAACCACGTGAACTGTCATCACCTGG CAACCCCAGCCCCAGCCTCAGCCCTGCCCCCTTTCCCTCCTTCCTGGAGTGGTGGCTACAGAAGC TTGGGGCCAACCCTGGCTCCTCTTTCCCCAGCTTCTGTCTGTCTCACTGTCTTCCCTCCCCTCCCC CAGCTGAGGTGTGGCCCTCAGGCCTGGTGCTGCCTTGGAGGGCTGGGGGAAGGAGTGTGTGGA GGAGGGAGGAGGGTGAAGACTGAGGCTAGGTGCCAGAATGGACTGGAGTGAAGGCGTGTCTAG AGTGTGGGCTGGCTGTTGTGCTGGAAAGCTGGGGACAGGTTGATGGTAATAAACTGCTCAATGA CCAGTGCTTCAGGCTCCAGAGCTCTTTGGAGAGATGGGTTGGGGCAGCTTACTCCAGCCCTGGC CCAAGGAGGCCCAGAAGTTGGAAAGAGATGGAATGTGGCTGGGAACATTGCATCCCAAAGAGCT TCTCAGTGGAGGAGGCTGGGGAAGGCATGAGGGGGCTCAGAGGCTCCTTGACTGGGACCAGGA TTGGGGGCCAGGGCTTGAGTAGGCCTCTCCACTCTCCTCCTTGGGGGTCCAGATTCCTTAGGAG CTTTGGGATGAGGCCCAGGAGGCTGCATTTTTCCAGGTCCTTAGTCTTGCCACCACACAGATGAT TCTGATTCATAGCCAAGATGAGGACACACTGATGTAGCTGATCTCTCATTTACAGAGGAGGATTC TAAAGTTCAGAGAGGGAAAGGGGCTTGCCTGAGGTCACGTAGATAATCAGCAGCACATTGAACGC TGCACTCCTGGGCTCCTGTCCCCAGCCCCCATTCAGACACGCTGACTCAGGAGGTCCAGGCCTCT AAGGCTTCTCTCCCTGGAGTGAGGGTGGAGGTGAGGGAGAGCTGGCACAAGCCCTCCCTCTGGA TCCTCCACTCCTGGGGATTATGAAGATATTCTGGAAAGATTTGTGCTTCAGAGGTAGACTGCAGA AAGCAAACAGTCTACCCAGCAGCTCTGAATGTCACCTGCCCTGGGGCTTACAGCACTATATGAGT TCCTGGCCTATCCTGCAAATATGCCCATGCTGGCCTTCTAAATAGCTGGTACATCCATCACCACTG ACGGGCCTGGCCTGGAAACCTGGTTTGTCCCCTGTCTTGATGGCCTACGAGAGGCCAAGTTCCAC TGGGCTGGGAAAAGTCACTTTGTCTGTCTTGTTCACCTGGAGCCTGACACACCGTAGGTACTGAG TACAAATAGCTTGATTTGGCTAGGCTTGGCTGCAGGGGGACGTGCCTAAAAGACATTCCGGGCAT TTGCACTTGGGAAACTTGCCTCACCTTCAGGCTTGTGGGGCCTCTCTATGCCCAATGAGTCCAGG CAGTCCTAGCAAGTACTCAGGAGAGCAGGGGTGGGTGTGACAGAGGCTGGCTCTGGATTGGGG GACAACAGAACCAGAGTAACTCCTCGCCTGTTGCTGCTTTGCAATGAATTTCCTTTACCTTTCTGG AACACAAGCTGCTGTGAACCAAACTGATATCAAGTGATTAGCTCACCGGGCCTTGGTTGCTTTTC AAAGATCCCCTTCAGCCCCCTGCCAGAGTCACTGCCCCATAATCACCATGTCAGAAGGGACCCTAG GGCATTCGTGTCCTATTTATCAATCTTCAGCACCACCTCTAAGATCTCTGAGAGAGGGTGGATCA GCCTCTGTGTAAACAAAAAGCTGTTAGGACTTGTTGCCTCTCAAGGTGGACTATTCTGTTTTCTG CCAGGACACTGCCATTCATGCATTGTCAGATATTTATTAAACAGCAGCAAAGTGCCAGCCAATTTG TCCTGGAGGAATTCATAGCCTCATGGGGCAAAAGTAAATAAACAGCTTATTACAATTCAACAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA (NCBI Reference Sequence: NM_001288802.1; SEQ ID NO: 11) Protein MPASISSIFPGPTLLLSCGSEELDSEDAPPCCRLALGEPPPYGAAPIGIPRPPPPRPGMHSPPPRPAPSPGT WESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWGDGSPRDYPPPEGFG GYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRFGLGSPLPSPRASPR PWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPSSASPALSRRGSLGE EGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPASCNGKLPLGAEESVA PPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLELRIEVQPRAHHRAHY ETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRITGKMVATASYEAVVS GTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHVPQGGGKVVSVQAAS VPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKLQWEEEATVNRLQSN EVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSLRGFPSASATPFGTDM DFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPETRGTTGCAQPPAVSF LPRPFPSDPYGGRGSSFSLGLPFSPPAPFRPPPLPASPPLEGPFPSQSDVHPLPAEGYNKVGPGYGPGEG APEQEKSRGGYSSGFRDSVPIQGITLEEGGCGTGGCECECVQEIALHVC (NCBI Reference Sequence: NP_001275731.1; SEQ ID NO: 12, 889 amino acids) Isoform 7 (This variant (7) is alternatively spliced at the 3′ end compared to transcript variant 1. This results in translation termination at a downstream stop codon, and a longer isoform (7) with a distinct C-terminus compared to isoform 1) cDNA GTAAACGTCTGACCTGGGGCCGTCGCTTAACCGTTTAGTTGCTGGGATGGGGCGGCGTTGGGGG TGCGGCCCTGAACCGGAGGGATTTAGAGACTGGAGACGCGGCCTCTAAGAGAGGTTGAAACTGT GTGTGTGTGGGAGAAAATGATAACCACCCTCCCATCTCTCCTACCCGCCAGCCTCGCCAGTATCT CCCACCGAGTCACGAATCTCCCATCTAACTCCCTCTCACACAACCCAGGCCTCTCCAAGCCTGACT TTCCCGGAAACTCCAGTCCAGGTCTTCCTTCCTCCTCCAGCCCAGGCCGGGACCTGGGGGCTCCT GCCGGATCCATGGGGGCGGCCAGCTGCGAGGATGAGGAGCTGGAATTTAAGCTGGTGTTCGGG GAGGAAAAGGAGGCCCCCCCGCTGGGCGCGGGGGGATTGGGGGAAGAACTGGACTCAGAGGAT GCCCCGCCATGCTGCCGTCTGGCCTTGGGAGAGCCCCCTCCCTATGGCGCTGCACCTATCGGTAT TCCCCGACCTCCACCCCCTCGGCCTGGCATGCATTCGCCACCGCCGCGACCAGCCCCCTCACCTG GCACCTGGGAGAGCCAGCCCGCCAGGTCGGTGAGGCTGGGAGGACCAGGAGGGGGTGCTGGGG GTGCTGGGGGTGGCCGTGTTCTCGAGTGTCCCAGCATCCGCATCACCTCCATCTCTCCCACGCCG GAGCCGCCAGCAGCGCTGGAGGACAACCCTGATGCCTGGGGGGACGGCTCTCCTAGAGATTACC CCCCACCAGAAGGCTTTGGGGGCTACAGAGAAGCAGGGGGCCAGGGTGGGGGGGCCTTCTTCA GCCCAAGCCCTGGCAGCAGCAGCCTGTCCTCGTGGAGCTTCTTCTCCGATGCCTCTGACGAGGCA GCCCTGTATGCAGCCTGCGACGAGGTGGAGTCTGAGCTAAATGAGGCGGCCTCCCGCTTTGGCC TGGGCTCCCCGCTGCCCTCGCCCCGGGCCTCCCCTCGGCCATGGACCCCCGAAGATCCCTGGAGC CTGTATGGTCCAAGCCCCGGAGGCCGAGGGCCAGAGGATAGCTGGCTACTCCTCAGTGCTCCTG GGCCCACCCCAGCCTCCCCGCGGCCTGCCTCTCCATGTGGCAAGCGGCGCTATTCCAGCTCGGGA ACCCCATCTTCAGCCTCCCCAGCTCTGTCCCGCCGTGGCAGCCTGGGGGAAGAGGGGTCTGAGC CACCTCCACCACCCCCATTGCCTCTGGCCCGGGACCCGGGCTCCCCTGGTCCCTTTGACTATGTG GGGGCCCCACCAGCTGAGAGCATCCCTCAGAAGACACGGCGGACTTCCAGCGAGCAGGCAGTGG CTCTGCCTCGGTCTGAGGAGCCTGCCTCATGCAATGGGAAGCTGCCCTTGGGAGCAGAGGAGTC TGTGGCTCCTCCAGGAGGTTCCCGGAAGGAGGTGGCTGGCATGGACTACCTGGCAGTGCCCTCC CCACTCGCTTGGTCCAAGGCCCGGATTGGGGGACACAGCCCTATCTTCAGGACCTCTGCCCTACC CCCACTGGACTGGCCTCTGCCCAGCCAATATGAGCAGCTGGAGCTGAGGATCGAGGTACAGCCTA GAGCCCACCACCGGGCCCACTATGAGACAGAAGGCAGCCGTGGAGCTGTCAAAGCTGCCCCTGG CGGTCACCCCGTAGTCAAGCTCCTAGGCTACAGTGAGAAGCCACTGACCCTACAGATGTTCATCG GCACTGCAGATGAAAGGAACCTGCGGCCTCATGCCTTCTATCAGGTGCACCGTATCACAGGCAAG ATGGTGGCCACGGCCAGCTATGAAGCCGTAGTCAGTGGCACCAAGGTGTTGGAGATGACTCTGC TGCCTGAGAACAACATGGCGGCCAACATTGACTGCGCGGGAATCCTGAAGCTTCGGAATTCAGAC ATTGAGCTTCGGAAGGGTGAGACGGACATCGGGCGCAAAAACACACGTGTACGGCTGGTGTTCC GGGTACACGTGCCCCAGGGCGGCGGGAAGGTCGTCTCAGTACAGGCAGCATCGGTGCCCATCGA GTGCTCCCAGCGCTCAGCCCAGGAGCTGCCCCAGGTGGAGGCCTACAGCCCCAGTGCCTGCTCT GTGAGAGGAGGCGAGGAACTGGTACTGACTGGCTCCAACTTCCTGCCAGACTCCAAGGTGGTGT TCATTGAGAGGGGTCCTGATGGGAAGCTGCAATGGGAGGAGGAGGCCACAGTGAACCGACTGCA GAGCAACGAGGTGACGCTGACCCTGACTGTCCCCGAGTACAGCAACAAGAGGGTTTCCCGGCCA GTCCAGGTCTACTTTTATGTCTCCAATGGGCGGAGGAAACGCAGTCCTACCCAGAGTTTCAGGTT TCTGCCTGTGATCTGCAAAGAGGAGCCCCTACCGGACTCATCTCTGCGGGGTTTCCCTTCAGCAT CGGCAACCCCCTTTGGCACTGACATGGACTTCTCACCACCCAGGCCCCCCTACCCCTCCTATCCCC ATGAAGACCCTGCTTGCGAAACTCCTTACCTATCAGAAGGCTTCGGCTATGGCATGCCCCCTCTG TACCCCCAGACGGGGCCCCCACCATCCTACAGACCGGGCCTGCGGATGTTCCCTGAGACTAGGG GTACCACAGGTTGTGCCCAACCACCTGCAGTTTCCTTCCTTCCCCGCCCCTTCCCTAGTGACCCGT ATGGAGGGCGGGGCTCCTCTTTCTCCCTGGGGCTGCCATTCTCTCCGCCAGCCCCCTTTCGGCCG CCTCCTCTTCCTGCATCCCCACCGCTTGAAGGCCCCTTCCCTTCCCAGAGTGATGTGCATCCCCTA CCTGCTGAGGGATACAATAAGGTAGGGCCAGGCTATGGCCCTGGGGAGGGGGCTCCGGAGCAG GAGAAATCCAGGGGTGGCTACAGCAGCGGCTTCCGAGACAGTGTCCCTATCCAGGGTATCACGC TGGAGGAAGTGAGTGAGATCATTGGCCGAGACCTGAGTGGCTTCCCTGCACCTCCTGGAGAAGA GCCTCCTGCCTGAACCACGTGAACTGTCATCACCTGGCAACCCCAGCCCCAGCCTCAGCCCTGCC CCCTTTCCCTCCTTCCTGGAGTGGTGGCTACAGAAGCTTGGGGCCAACCCTGGCTCCTCTTTCCC CAGCTTCTGTCTGTCTCACTGTCTTCCCTCCCCTCCCCCAGCTGAGGTGTGGCCCTCAGGCCTGG TGCTGCCTTGGAGGGCTGGGGGAAGGAGTGTGTGGAGGAGGGAGGAGGGTGAAGACTGAGGCT AGGTGCCAGAATGGACTGGAGTGAAGGCGTGTCTAGAGTGTGGGCTGGCTGTTGTGCTGGAAA GCTGGGGACAGGTTGATGGTAATAAACTGCTCAATGACCAGTGCTTCAGGCTCCAGAGCTCTTTG GAGAGATGGGTTGGGGCAGCTTACTCCAGCCCTGGCCCAAGGAGGCCCAGAAGTTGGAAAGAGA TGGAATGTGGCTGGGAACATTGCATCCCAAAGAGCTTCTCAGTGGAGGAGGCTGGGGAAGGCAT GAGGGGGCTCAGAGGCTCCTTGACTGGGACCAGGATTGGGGGCCAGGGCTTGAGTAGGCCTCT CCACTCTCCTCCTTGGGGGTCCAGATTCCTTAGGAGCTTTGGGATGAGGCCCAGGAGGCTGCATT TTTCCAGGTCCTTAGTCTTGCCACCACACAGATGATTCTGATTCATAGCCAAGATGAGGACACACT GATGTAGCTGATCTCTCATTTACAGAGGAGGATTCTAAAGTTCAGAGAGGGAAAGGGGCTTGCCT GAGGTCACGTAGATAATCAGCAGCACATTGAACGCTGCACTCCTGGGCTCCTGTCCCCAGCCCCC ATTCAGACACGCTGACTCAGGAGGTCCAGGCCTCTAAGGCTTCTCTCCCTGGAGTGAGGGTGGA GGTGAGGGAGAGCTGGCACAAGCCCTCCCTCTGGATCCTCCACTCCTGGGGATTATGAAGATATT CTGGAAAGATTTGTGCTTCAGAGGTAGACTGCAGAAAGCAAACAGTCTACCCAGCAGCTCTGAAT GTCACCTGCCCTGGGGCTTACAGCACTATATGAGTTCCTGGCCTATCCTGCAAATATGCCCATGC TGGCCTTCTAAATAGCTGGTACATCCATCACCACTGACGGGCCTGGCCTGGAAACCTGGTTTGTC CCCTGTCTTGATGGCCTACGAGAGGCCAAGTTCCACTGGGCTGGGAAAAGTCACTTTGTCTGTCT TGTTCACCTGGAGCCTGACACACCGTAGGTACTGAGTACAAATAGCTTGATTTGGCTAGGCTTGG CTGCAGGGGGACGTGCCTAAAAGACATTCCGGGCATTTGCACTTGGGAAACTTGCCTCACCTTCA GGCTTGTGGGGCCTCTCTATGCCCAATGAGTCCAGGCAGTCCTAGCAAGTACTCAGGAGAGCAG GGGTGGGTGTGACAGAGGCTGGCTCTGGATTGGGGGACAACAGAACCAGAGTAACTCCTCGCCT GTTGCTGCTTTGCAATGAATTTCCTTTACCTTTCTGGAACACAAGCTGCTGTGAACCAAACTGATA TCAAGTGATTAGCTCACCGGGCCTTGGTTGCTTTTCAAAGATCCCCTTCAGCCCCCTGCCAGAGT CACTGCCCCATAATCACCATGTCAGAAGGGACCCTAGGGCATTCGTGTCCTATTTATCAATCTTCA GCACCACCTCTAAGATCTCTGAGAGAGGGTGGATCAGCCTCTGTGTAAACAAAAAGCTGTTAGGA CTTGTTGCCTCTCAAGGTGGACTATTCTGTTTTCTGCCAGGACACTGCCATTCATGCATTGTCAGA TATTTATTAAACAGCAGCAAAGTGCCAGCCAATTTGTCCTGGAGGAATTCATAGCCTCATGGGGC AAAAGTAAATAAACAGCTTATTACAATTCAACAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAA (NCBI Reference Sequence: NM_001320043.1; SEQ ID NO: 13) Protein MITTLPSLLPASLASISHRVTNLPSNSLSHNPGLSKPDFPGNSSPGLPSSSSPGRDLGAPAGSMGAASCEDE ELEFKLVFGEEKEAPPLGAGGLGEELDSEDAPPCCRLALGEPPPYGAAPIGIPRPPPPRPGMHSPPPRPA PSPGTWESQPARSVRLGGPGGGAGGAGGGRVLECPSIRITSISPTPEPPAALEDNPDAWGDGSPRDYPP PEGFGGYREAGGQGGGAFFSPSPGSSSLSSWSFFSDASDEAALYAACDEVESELNEAASRFGLGSPLPSP RASPRPWTPEDPWSLYGPSPGGRGPEDSWLLLSAPGPTPASPRPASPCGKRRYSSSGTPSSASPALSRR GSLGEEGSEPPPPPPLPLARDPGSPGPFDYVGAPPAESIPQKTRRTSSEQAVALPRSEEPASCNGKLPLG AEESVAPPGGSRKEVAGMDYLAVPSPLAWSKARIGGHSPIFRTSALPPLDWPLPSQYEQLELRIEVQPRA HHRAHYETEGSRGAVKAAPGGHPVVKLLGYSEKPLTLQMFIGTADERNLRPHAFYQVHRITGKMVATA SYEAVVSGTKVLEMTLLPENNMAANIDCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHVPQGGGKV VSVQAASVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIERGPDGKLQWEEEAT VNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNGRRKRSPTQSFRFLPVICKEEPLPDSSLRGFPSASA TPFGTDMDFSPPRPPYPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPETRGTTGCA QPPAVSFLPRPFPSDPYGGRGSSFSLGLPFSPPAPFRPPPLPASPPLEGPFPSQSDVHPLPAEGYNKVGP GYGPGEGAPEQEKSRGGYSSGFRDSVPIQGITLEEVSEIIGRDLSGFPAPPGEEPPA (NCBI Reference Sequence: NP_001306972.1; SEQ ID NO: 14, 965 amino acids)

As explained above, all isoforms of NFATC4 are included in the definition of NFATC4 in the context of the present invention. However, in a preferred embodiment, cells secreting SEV present in the composition for use according to the invention express isoform 2 of NFATC4 disclosed in Table 1 above, a 902 amino acids protein (SEQ ID NO:4), or variants thereof. Other preferred isoforms are isoforms 4 (SEQ ID NO:8, 832 amino acids) and 7 (SEQ ID NO:14, 965 amino acids) disclosed in Table 1 above, because these isoforms share with isoform 2 the sequence of variant “ΔNFATC4” described below, and because SEV of cells expressing ΔNFATC4 have been shown by the inventors as highly efficient.

In the context of the present invention, not only all isoforms of NFATC4 are included in the definition of NFATC4, but also all variants maintaining the function of NFATC4 or with increased function compared to native NFATC4. These notably include allelic variants.

A variant of particular interest is ΔNFATC4, which corresponds to isoform 2 of NFATC4 disclosed in Table 1 above, truncated of its 521 N-terminal amino acids (see Rescued NF-AT3 in FIG. 1A of Molkentin et al. (1998). Cell 93: 215-228):

ΔNFATC4 amino acid sequence is presented below:

DCAGILKLRNSDIELRKGETDIGRKNTRVRLVFRVHVPQGGGKVVSVQAA SVPIECSQRSAQELPQVEAYSPSACSVRGGEELVLTGSNFLPDSKVVFIE RGPDGKLQWEEEATVNRLQSNEVTLTLTVPEYSNKRVSRPVQVYFYVSNG RRKRSPTQSFRFLPVICKEEPLPDSSLRGFPSASATPFGTDMDFSPPRPP YPSYPHEDPACETPYLSEGFGYGMPPLYPQTGPPPSYRPGLRMFPETRGT TGCAQPPAVSFLPRPFPSDPYGGRGSSFSLGLPFSPPAPFRPPPLPASPP LEGPFPSQSDVHPLPAEGYNKVGPGYGPGEGAPEQEKSRGGYSSGFRDSV PIQGITLEEVSEIIGRDLSGFPAPPGEEPPA (SEQ ID NO: 15, 381 amino acids)

In the context of the invention, a composition comprising SEV of cells expressing any NFATC4 variant comprising ΔNFATC4 amino acid sequence (SEQ ID NO:15) may be used for the treatment of cancer or for the treatment or prevention of metastatic cancer.

When cells express a variant of NFATC4, said variant preferably comprises the 85 C-terminal amino acids of isoform 2 of NFATC4 disclosed in Table 1 above (which are the same as the 85 C-terminal amino acids of isoform 2 of ΔNFATC4).

Cells Expressing NFATC4

In the context of the invention, any cell expressing NFATC4 may be used for the preparation of SEV. Non-limitative examples of cells expressing NFATC4 include:

-   -   cancer cells with low invasive capacity, and     -   any cells that have been induced to express NFATC4.

In a preferred embodiment of the invention, SEV of cells expressing NFATC4 have been purified from cancer cells with low invasive capacity. Indeed, such cancer cells generally express NFATC4.

In the present description, “invasive capacity” or “relative invasive capacity” refers to the ability of cancer cells to move through the extracellular matrix (ECM) into neighboring tissues in a process that involves ECM degradation and proteolysis. Invasive capacity of particular cancer cells may be tested in vitro or in vivo in invasion assays. In vitro invasion assays generally rely on the use of a natural or reconstituted matrix, which is applied over a filter (also referred to as a membrane) of suitable pore size (generally 5, 8, 10, or 12 μm) depending on the tested cancer cells, located above a medium comprising chemoattractants for the cancer cells to be tested. An invasion index may then be calculated based on the number of cells able to cross the matrix and the filter to reach the chemoattractive medium. The relative invasive capacity is calculated as the ratio of the number of invasive cells relative to the number of known low (such as T47D, MCF7) or high (such as MDA-MB-231, SUM159PT) invasive cells in the same assay.

Various types of natural or reconstituted matrices may be used, including but not limited to natural matrix isolated from cells (such as “Matrigel”, a gelatinous protein mixture secreted by Engelbreth-Holm-Swarm (EHS) mouse sarcoma cells), a collagen I or IV gel matrix, and a Laminin I gel matrix. The most common matrix used in in vitro invasion assays is Matrigel.

As explained above, the filter pore size should be adapted to the tested cell type, and is generally selected from 5, 8, 10, and 12 μm, depending on the cell type. For breast cancer cells, an 8-μm pore filter will generally be suitable.

Various chemoattractants may also be used in the chemoattractive medium, depending on the type of tested cells. A commonly used chemoattractant is conditioned NIH-3T3 medium.

The invasion level depends on various parameters, including the cell type, the type and thickness of the matrix, the duration of the assay, and the initial cell density over the filter. For defining the invasive capacity of a cell sample, reference cell samples of low or high invasive capacity should thus be tested in parallel with the new cell sample. The invasive capacity of the new cell sample is then assessed by comparison of its invasion index to the invasion index of reference cell samples.

For most types of cancers, cell lines of low or high invasive capacity have been defined in the prior art. In the context of the invention, cancer cells with low invasive capacity” refers to cancer cells having an invasion index in an in vitro invasion assay that is lower or equal to the invasion index of at least one cancer cell line of the same cellular type known as having low invasive capacity.

Examples of cancer cell lines of low or high invasive capacity are described in Table 2 below.

TABLE 2 Known cancer cell lines of low or high invasive capacity by cellular type. Cancer cell lines of low Cancer cell lines of high Cellular type invasive capacity invasive capacity Breast breast cancer cells breast cancer cells that do cancer expressing the estrogen not express the estrogen receptor α (ERA), such as receptor α (ERA), such as human cell lines T-47D, human cell lines MDA-MB- MCF7, BT-474, ZR-75-1, 231 and SUM159PT, and and mouse cell line 67NR mouse cell line 4T1 Melanoma SKmel23, WM164 MV3, SKmel28, WM.266.4 Pancreatic BXPC3, AsPC-1 cancer Glioblastome U-87 MG

In the case of breast cancer cells, breast cancer cells expressing the estrogen receptor a (ERA) generally have low invasive capacity, SEV of cells expressing NFATC4 may thus be purified from breast cancer cells expressing the estrogen receptor α (ERA).

Alternatively, SEV of cells expressing NFATC4 may have been purified from any other cells that have been induced to express NFATC4.

By “cells that have been induced to express NFATC4”, it is meant cells that do or do not naturally express NFATC4 but that have been treated with at least one compound able to induce NFATC4 expression or to enhance NFATC4 activity in the cells. When the starting cells do not express NFATC4, then the treatment should be able to generate NFATC4 expression or to enhance NFATC4 activity in the starting cells. When the starting cells already express NFATC4, then the treatment should be able to increase NFATC4 expression or to enhance NFTAC4 activity in the starting cells.

Any type of starting cells may be used, including but not limited to:

-   -   cancer cells with low invasive capacity, as defined above, and     -   healthy cells.

In both cases, either primary cells or cell lines may be used. The cellular type of starting cells is not particularly limited. For cancer cells with low invasive capacity, any type of cancer cells as described below may be used. In the case of healthy cells, any cellular type may be used, including fibroblasts, epithelial cells, HEK293 (Human Embryonic Kidney), dendritic cells, stem cells. By “healthy cells”, it is meant cells that do not have a tumoral origin and come or are derived from normal tissue. In other words, healthy cells refer to either primary non-cancerous cells, or to cell lines derived from normal, healthy primary cells. In addition, both adherent and suspension cells may be used, although adherent cells are preferred.

For the treatment of a human patient, human cells (primary or cell lines, adherent or suspension, cancer cells with low invasive capacity or healthy cells) will preferably be used.

When healthy cells are used for induction of NFATC4 expression, in a preferred embodiment, said healthy cells are autologous cells (in particular autologous fibroblasts) from the patient to be treated. In another embodiment, said healthy cells are human embryonic cells, in particular HEK293T cells.

This indeed limits any immune response to the administered composition of SEV.

Any suitable mean for inducing NFATC4 expression may be used.

In a preferred embodiment, for induction of NFATC4 expression, cells have been transfected by an expression vector comprising a nucleic acid molecule encoding NFATC4. By “transfection”, it is meant the process of deliberately introducing nucleic acids into cells by any suitable technology known to those skilled in the art. In particular, in the context of the invention, the term transfection is intended to include both viral and non-viral methods for introducing nucleic acids into cells.

An “expression vector” as used herein refers to a vector comprising a nucleic acid molecule encoding NFATC4 and elements necessary to allow expression thereof. In particular, the nucleic acid molecule encoding NFATC4 is operably linked to appropriate regulatory sequences.

As used herein, the term “regulatory elements” or “regulatory sequence” refers to any element that allows, contributes or modulates the expression of nucleic acid molecule(s) in a given host cell or subject, including replication, duplication, transcription, splicing, translation, stability and/or transport of the nucleic acid(s) or its derivative (i.e. mRNA). It will be appreciated by those skilled in the art that the choice of the regulatory sequences can depend on such factors as the vector itself and the cells to be transfected, and will be easily selected by those skilled in the art based on common general knowledge and publications on this topic. Suitable promoters for constitutive expression in eukaryotic systems include viral promoters, such as SV40 promoter, the cytomegalovirus (CMV) immediate early promoter or enhancer, the adenovirus early and late promoters, the thymidine kinase (TK) promoter of herpes simplex virus (HSV)-1 and retroviral long-terminal repeats (e.g. MoMuLV and Rous sarcoma virus (RSV) LTRs) as well as cellular promoters such as the phosphoglycero kinase (PGK) promoter. Examples of suitable promoters for a lentiviral vector include those present in pLVX-tdTomato-C1 Vector commercialized by Clontech.

The expression vector may notably be selected from plasmid and viral expression vectors. A “plasmid vector” as used herein refers to a replicable DNA construct. Representative examples of suitable plasmid vectors include, without limitation, pREP4, pCEP4 (Invitrogen), pCI (Promega), pVAX (Invitrogen) and pGWiz (Gene Therapy System Inc). For transfection, a plasmid vector may be complexed to lipids or polymers to form particulate structures such as liposomes, lipoplexes or nanoparticles.

The term “viral vector” as used herein refers to a nucleic acid vector that includes at least one element of a virus genome and may be packaged into a viral particle. The terms “virus”, “virions”, “viral particles” and “viral vector particle” are used interchangeably to refer to viral particles that are formed when the nucleic acid vector is transduced into an appropriate cell or cell line according to suitable conditions allowing the generation of viral particles. In the context of the present invention, the term “viral vector” has to be understood broadly as including nucleic acid vector (e.g. DNA viral vector) as well as viral particles generated thereof. The term “infectious” refers to the ability of a viral vector to infect and enter into a host cell or subject.

In a preferred embodiment, a viral expression vector comprising a nucleic acid molecule encoding NFATC4 is used.

Viral vectors can be replication-competent or -selective (e.g. engineered to replicate better or selectively in specific host cells), or can be genetically disabled so as to be replication-defective or replication-impaired. Typically, such vectors are commercially available (e.g. in Invitrogen, Stratagene, Amersham Biosciences, Promega, etc.) or available from depositary institutions such as the American Type Culture Collection (ATCC, Rockville, Md.) or have been the subject of numerous publications describing their sequence, organization and methods of producing, allowing the artisan to apply them.

Representative examples of suitable viral vectors are generated from a variety of different viruses (e.g. retrovirus, adenovirus, adenovirus-associated virus (AAV), poxvirus, herpes virus, measles virus, foamy virus, alphavirus, vesicular stomatis virus, etc). As described above, the term “viral vector” encompasses vector DNA, genomic DNA as well as viral particles generated thereof, and especially infectious viral particles.

In a preferred embodiment, a retroviral expression vector (and in particular a lentiviral expression vector) comprising a nucleic acid molecule encoding NFATC4 is used. Retroviruses have the property of infecting, and in most cases integrating into, dividing cells and in this regard are particularly appropriate for use in the context of the present invention for producing cells expressing high levels of NFATC4. A suitable retrovirus generally contains the LTR sequences, an encapsidation region and a nucleic acid molecule encoding NFATC4. The recombinant retrovirus can be derived from a retrovirus of any origin (murine, primate, feline, human, etc.) and in particular from the MoMuLV (Moloney murine leukemia virus), MVS (Murine sarcoma virus), Friend murine retrovirus (Fb29), Murine Embryonic Stem Cell Virus (MESV), LN virus or Murine Stem Cell Virus (MSCV). It is propagated in an encapsidation cell line which is able to supply in trans the viral polypeptides gag, pol and/or env which are required for constituting a viral particle. Such cell lines are described in the literature (PA317, Psi CRIP GP +Am-12, HEK 293T etc.). The retroviral (and more particularly lentiviral) expression vector used in the invention may contain modifications, in particular in the LTRs (replacement of the promoter region with a eukaryotic promoter) or the encapsidation region (replacement with a heterologous encapsidation region). Examples of commercial lentiviral vectors that may be used in the context of the present invention include pLVX-tdTomato-C1 Vector commercialized by Clontech.

However, other types of viral expression vectors comprising a nucleic acid molecule encoding NFATC4 may be used.

Examples of viral vectors that are useful in the context of the invention include adenoviral vectors, which may be derived from a variety of human or animal sources (e.g. canine, ovine, simian adenovirus, etc). Any serotype can be employed with a special preference for human adenoviruses and a specific preference for subgenus C such as Ad2, Ad5, Ad6, and subgenus B such as Ad11, Ad34 and Ad35. The cited adenovirus are available from ATCC or have been the subject of numerous publications describing their sequence, organization and methods of producing, allowing the artisan to apply them. When an adenoviral vector is used, it is preferably an E1-defective adenoviral vector with an E1 deletion extending from approximately positions 459 to 3328 or from approximately positions 459 to 3510 (by reference to the sequence of Ad5 disclosed in the GenBank under the accession number M73260.1). The cloning capacity can further be improved by deleting additional portion(s) of the adenoviral genome (all or part of the non-essential E3 region (e.g. deletion from approximately positions 27867 to 30743) or of other essential E2 and/or E4 regions. The nucleic acid molecule encoding NFATC4 can then be inserted in any location of the adenoviral genome, with a specific preference for insertion in replacement of the E1 and/or E3 region. They may be positioned in sense or antisense orientation relative to the natural transcriptional direction of the region in question.

Other examples of viral vectors that may be used in the context of the invention include poxvirus vectors such as fowlpox vectors (e.g. FP9), canarypox vectors (e.g. ALVAC) and vaccinia virus vectors, the latter being preferred. Suitable vaccinia viruses include without limitation the Copenhagen strain, the Wyeth strain, NYVAC and the modified Ankara (MVA) strain. The general conditions for constructing and producing recombinant poxvirus are well known in the art. The nucleic acid molecule encoding NFATC4 is preferably inserted within the poxviral genome in a non-essential locus. Thymidine kinase gene is particularly appropriate for insertion in Copenhagen vaccinia vectors and deletion II or III for insertion in MVA vector.

Other viral vectors suitable in the context of the invention are morbillivirus which can be obtained from the paramyxoviridae family, with a specific preference for measles virus. Insertion of the nucleic acid molecule encoding NFATC4 between P and M genes or between H and L genes is particularly appropriate.

Alternatively, instead of transfecting starting cells with an expression vector comprising a nucleic acid molecule encoding NFATC4, starting cells may be induced to express NFATC4 or to show enhanced NFATC4 activity by any other suitable mean. Notably, starting cells may be contacted with a compound or transfected by an expression vector comprising a nucleic acid molecule encoding a protein able to induce or increase NFATC4 expression or to enhance NFATC4 activity.

Cancer Treatment

A composition comprising SEV of cells expressing NFATC4 may be used in the treatment of cancer or in the treatment or prevention of metastatic cancer.

In the present description, “cancer” refers to a malignant neoplasm characterized by deregulated or uncontrolled cell growth. In particular, a “cancer cell” refers to a cell with deregulated or uncontrolled cell growth.

The term “cancer” includes primary malignant tumours (also referred to as “primary cancer”, corresponding to, those whose cells have not migrated to sites in the subject's body other than the site of the original tumor) and secondary malignant tumours (also referred to as “secondary cancer” or “metastatic cancer”, those arising from metastasis, the migration of tumour cells to secondary sites that are different from the site of the original tumour).

The type of cancers that may be treated or of metastatic cancer that may be treated or prevented using a composition comprising SEV of cells expressing NFATC4 is not particularly limited. Such cancer may notably be selected from the group of solid cancers. Solid cancers notably include carcinomas (cancers that begin in the lining layer (epithelial cells) of organs, glands, or body structures, also known as “epithelial cancers”), sarcomas (cancers that start in connective tissue, such as cartilage, fat, muscle, tendon, or bone), and brain cancers (cancers that start in brain cells, such as glioma, glioblastoma, and astrocytoma). A cancer is further named after the part of the body where it originated. When cancer spreads, it keeps this same name. In the context of the invention, the cancer may in particular be selected from the group of carcinomas, including but not limited to breast carcinoma, melanoma, ovarian carcinoma, digestive carcinomas (also referred as gastrointestinal carcinomas, including colorectal carcinoma, oesophageal carcinoma, gastric carcinoma, pancreatic carcinoma, hepatocellular carcinoma, cholangiocellular carcinoma and teratocarcinoma), lung carcinoma, prostate carcinoma, and throat carcinoma, particularly of human subject. In the context of the invention, the cancer may also be selected from the group of brain tumors, including but not limited to glioblastoma, particularly of human subject. In preferred embodiments, the cancer may in particular be selected from breast carcinoma, melanoma, pancreatic carcinoma, colorectal carcinoma, glioblastoma and lung carcinoma; more preferably said cancer is selected from breast carcinoma, melanoma, pancreatic carcinoma, and glioblastoma, most preferably said cancer is breast carcinoma, in particular metastatic breast carcinoma.

Such cancer may also be selected from the group of hematopoietic cancers, and in particular from the group consisting of leukaemias, lymphomas, and myelomas, particularly of human patient.

In the present description, the term “treating” or “treatment” means an improvement of the patient's disease, which may be observed at the clinical, histological, biochemical level. In particular, any alleviation of a clinical, histological or biochemical symptom of the disease is included in the terms “treating” and “treatment”. In the context of primary cancer, “treating” or “treatment” thus notably relates to the fact to reduce cancer growth or spreading by metastasis. In the context of a metastatic cancer, “treating” or “treatment” thus notably relates to the fact to reduce metastatic cancer growth or further spreading by metastasis. Treatment may require administration of an agent and/or treatment more than once. Treatment also includes the possibility to combine SEV of cells expressing NFATC4 with another anticancer agent. In this case, the two anticancer agents (SEV of cells expressing NFATC4 and the other anticancer agent) may be administered sequentially or simultaneously. In the present description, the term “sequentially” refers to administration (one or more administrations) of a first anticancer agent (SEV of cells expressing NFATC4 or the other anticancer agent), followed by stopping of administration of the first anticancer agent and administration (one or more administrations) of the second anticancer agent (the other anticancer agent or SEV of cells expressing NFATC4). In the present description, the term “simultaneously” refers to administration of the two anticancer agents (SEV of cells expressing NFATC4 and the other anticancer agent) over a same period of time. This includes administration of the two anticancer agents (SEV of cells expressing NFATC4 and the other anticancer agent) in one composition containing both agents or in separate compositions containing each one of the two agents. An intermixed administration (alternation of administration of one agent and the other) over a same period of time is considered simultaneous administration.

The anticancer agent might be selected from surgical treatment, chemotherapy, radiotherapy, immunotherapy, and cell therapy.

In the present description, the term “preventing” or “prevention” means the fact to preclude or delay the onset or reduce the intensity of clinical, histological or biochemical events associated with the disease. In the context of cancer, “preventing” or “prevention” thus notably relates to the fact to inhibit, at least partially, new cancer growth or spreading. Prevention may require administration of an agent and/or treatment more than once. In the context of prevention also, SEV of cells expressing NFATC4 may be combined with another anticancer agent, either sequentially or simultaneously.

In the present description, the term “patient” refers to mammals, e. g., humans, dogs, cows, horses, kangaroos, pigs, sheep, goats, cats, mice, rabbits, rats, and transgenic non-human animals. In preferred embodiments of the present invention, a subject is a human subject.

The composition comprising SEV of cells expressing NFATC4 is administered in therapeutically efficient amounts.

As used herein, a “therapeutically efficient amount” refers to an amount sufficient for the intended use. For the anti-cancer composition according to the invention, it refers to an amount sufficient to reduce cancer growth or spreading.

In mice, a weekly dose of 50.10⁸ pp SEV (number of particles detected by NanoSight apparatus, commercialized by Malvern) per mouse was used successfully, and a weekly dose of 10⁸ to 10¹¹ pp SEV may be expected to be successful, knowing that mice have a total blood volume of about 1.5 mL. Suitable doses may be extrapolated for other species based on the total blood volume. For instance, in humans (total blood volume of about 5 L), a dose of at least about 15.10¹² SEV may be contemplated. In the context of the present invention, the number of SEV present in a composition is preferably determined using a NanoSight apparatus (commercialized by Malvern), in which case the number of SEV is referred to as “pp”, corresponding to the number of particles detected by NanoSight apparatus. Thus, in humans (total blood volume of about 5 L), a dose of at least about 15.10¹² pp SEV may be contemplated.

The administered dose may vary depending on the subject age, body surface area or body weight, or on the administration route and associated bioavailability. Such dose adaptation is well known to those skilled in the art.

The composition comprising SEV of cells expressing NFATC4 may be administered by any suitable administration route, including intravenous, intratumoral, topical, intranasal, rectal, oral, transdermal, subcutaneous, and sublingual routes. In a preferred embodiment, the composition comprising SEV of cells expressing NFATC4 is intended to be administered by intravenous or intratumoral route.

Depending on the selected route of administration, those skilled in the art will know how to formulate the above defined compounds or pharmaceutically acceptable salts thereof in order to optimize in vivo delivery and bioavailability. In particular, the above defined SEV may be formulated with suitable pharmaceutically acceptable carriers, excipients, vehicles, preservatives, solubilizing agents, stabilizers, wetting agents, emulsifiers, sweeteners, dyes, flavoring, salts intended to modify osmotic pressure, buffers, taste correctors, and antioxidants. These compounds are well-known to those skilled in the art. Details on these chemicals can be found in the latest edition of Remington's Pharmaceutical Sciences (Maack Publishing Co., Easton, Pa.). The selection of the optimal delivery formulation will be selected by those skilled in the art depending on the selected administration route.

For intravenous, intratumoral or intranasal administration, aqueous suspensions, isotonic saline solutions, or sterile, injectable solutions that contain pharmacologically compatible dispersing agents and/or wetting agents may be used. As an excipient, water, alcohols, polyols, glycerol, vegetable oils, etc., may be used.

For topical administration, compositions may be presented in the form of a gel, a paste, an ointment, a cream, a lotion, an aqueous or aqueous-alcohol liquid suspension, an oily solution, a dispersion of the lotion or serum type, an anhydrous or lipophilic gel, an emulsion with a liquid or semi-solid milk-type consistency obtained by dispersing a fatty phase in an aqueous phase or vice versa, suspensions or emulsions of a soft or semi-solid cream- or gel-type consistency, or alternatively microemulsions, microcapsules, microparticles, or vesicular dispersions of the ionic and/or nonionic type. These compositions are prepared according to standard methods. Moreover, a surfactant can be included in the composition in order to enable deeper penetration of SEV. An agent enabling an increased penetration may be selected, for example, from mineral oil, ethanol, triacetin, glycerin and propylene glycol; cohesion agents are selected, for example, from the group comprising polyisobutylene, polyvinyl acetate, polyvinyl alcohol, and thickening agents.

For rectal administration, suppositories, which are prepared with binders that melt at rectal temperatures, for example cocoa butter or semi-solid or liquid polyols such as polyethylene glycols, waxes, natural or hydrogenated oils, fats, etc., can be used. Suitable unit dose administration formulations for oral administration notably include tablets, coated tablets, pills, capsules and soft gelatin capsules, oral powders, granules, solutions and suspensions.

When a solid composition in tablet form is prepared, the principal active ingredient may be mixed with a pharmaceutical vehicle, such as gelatin, starch, lactose, stearic acid or magnesium stearate, talc, gum arabic or analogues. The tablets may be coated with saccharose or other suitable materials or even be treated so as to have a prolonged or delayed activity and to release continuously a predetermined quantity of the active ingredient.

A capsule preparation may be obtained by mixing the active ingredient with a thinner and pouring the mixture obtained into soft or hard capsules, with excipients such as vegetable oils, waxes, fats, semi-solid or liquid polyols, etc.

A preparation in syrup or elixir form can contain the active ingredient together with a sweetener, an antiseptic, as well as an agent giving taste and a suitable dye. Excipients may be used, such as water, polyols, saccharose, invert sugar, glucose, etc.

Powders or water-dispersible granules may contain the active ingredient in a mixture with dispersing agents, wetting agents, and suspending agents, together with taste correctors and sweeteners.

For subcutaneous administration, any suitable pharmaceutically acceptable vehicle may be used. In particular, a pharmaceutically acceptable oil vehicle, such as sesame oil, may be used.

Method for Preparing a Composition Comprising SEV of Cells Expressing NFATC4 from a Sample of Healthy Cells of a Cancer Patient

In a second aspect, the present invention also relates to a method for preparing a composition comprising SEV of cells expressing NFATC4 from a sample of cells, comprising:

-   -   a) Inducing NFATC4 expression or activity in said cells;     -   b) Culturing said induced cells in SEV-free culture medium,         under conditions permitting their expansion; and     -   c) Purifying SEV of the induced cells.

In step a), NFATC4 expression or activity is induced in starting cells, as described above. In particular, any type of starting cells disclosed above may be used (with a preference for healthy cells, in particular autologous cells and notably autologous fibroblasts of the patient to be treated, or a fibroblast cell line such as WI38, which is already approved for the production of vaccines), and any type of induction of NFATC4 expression or activity disclosed above may be used (with a preference for use of a viral, and more particularly lentiviral, vector for inducing NFATC4 expression).

In step b), induced cells are cultured in SEV-free culture medium, under conditions permitting their expansion. Some commercialized culture media are already SEV-free. However, for media containing animal driven components (e.g. serum), SEV depletion of the medium should be conducted. This may be performed by spinning the culture medium at 30,000 to 40,000 RPM for 8-16 hours (for instance, overnight) at about 4° C.

Conditions permitting expansion of induced cells vary depending on the type of starting cells (primary cells/cell line; cellular type, adherent/suspension cells) used in the method, and may be determined by skilled persons based on their common general knowledge about cell culture. The important point is that cells should be in good condition, since cell death and apoptotic bodies could lead to contamination of the SEV pellet. Conditions permitting amplification and maintenance of induced cells in exponential growth should thus be used, and SEV should be purified before the end of the exponential phase of growth, i.e. before the plateau, when cell death becomes significant.

In step c), SEV are purified from the culture supernatant, as described above. In particular, any method of purification described above may be used, with a preference for differential centrifugation, as described above.

For therapeutic purposes, the whole method should preferably be performed under sterile conditions.

In Vitro Methods for Determining or Predicting the Therapeutic Efficiency of a Treatment with a Composition Comprising SEV of Cells Expressing NFATC4 in a Cancer Patient

The inventors have shown that SEV of cells expressing NFATC4 induce Transforming growth factor beta 1 (TGFß1) expression in cancer cells, and that in vivo efficiency of the treatment of cancer in animal models correlates with an increase in TGFß1 expression in the treated patient.

Therefore, in a third aspect, the present invention also relates to an in vitro method for determining the therapeutic efficiency of a treatment with a composition comprising SEV by cells expressing NFATC4 in a treated cancer patient, from a first biological sample of said cancer patient taken before the beginning of the treatment and a second corresponding biological sample of cancer patient after the beginning of the treatment, comprising:

-   -   a) Measuring in vitro at least the Transforming growth factor         beta 1 (TGFß1) expression level in said first and second         biological samples;     -   b) Comparing at least the measured TGFß1 expression levels; and     -   c) Determining the efficiency of the treatment with a         composition comprising SEV of cells expressing NFATC4 in said         treated cancer patient from said comparison, wherein the         treatment is considered efficient if at least the TGFß1         expression level measured in the biological sample after the         beginning of the treatment is higher than at least the TGFß1         expression level in the biological sample after the beginning of         the treatment.

Since the efficiency of the treatment with SEV of cells expressing NFATC4 is correlated to an increase in TGFß1 expression in the treated patient, the above method relies on comparison of TGFß1 expression level in two successive biological samples of the patient, the first one taken before the beginning of the treatment with SEV of cells expressing NFATC4, and the second one taken after the beginning of the treatment with SEV of cells expressing NFATC4.

A “biological sample” refers to any sample of the patient in which TGFß1 expression may be measured. Such samples include notably a tumor sample, a blood sample, a serum sample, and a urine sample. For comparison purpose, the first and second samples should preferably be of the same nature (e.g. two tumor samples, two blood samples, two serum samples, or two urine samples).

“Transforming growth factor beta 1” or “TGFß1” refers to a protein encoded by the human gene with the official symbol TGFß1 in Entrez Gene database. (Gene ID: 7040). The TGFß1 gene is also known as “TGF-beta-1”, “prepro-transforming growth factor beta-1”, “CED”, “LAP” or “latency-associated peptide”, “DPD1”, “TGFB”, and “TGFbeta”. The cDNA and protein sequences of TGFß1 are mentioned in Table 3 below:

TABLE 3 cDNA and protein sequences of human TGFβ1. TGFβ1 cDNA sequence AGCCGGTCCCCGCCGCCGCCGCCCTTCGCGCCCTGGGCCATCTCCCTCCC ACCTCCCTCCGCGGAGCAGCCAGACAGCGAGGGCCCCGGCCGGGGGCAGG GGGGACGCCCCGTCCGGGGCACCCCCCCGGCTCTGAGCCGCCCGCGGGGC CGGCCTCGGCCCGGAGCGGAGGAAGGAGTCGCCGAGGAGCAGCCTGAGGC CCCAGAGTCTGAGACGAGCCGCCGCCGCCCCCGCCACTGCGGGGAGGAGG GGGAGGAGGAGCGGGAGGAGGGACGAGCTGGTCGGGAGAAGAGGAAAAAA ACTTTTGAGACTTTTCCGTTGCCGCTGGGAGCCGGAGGCGCGGGGACCTC TTGGCGCGACGCTGCCCCGCGAGGAGGCAGGACTTGGGGACCCCAGACCG CCTCCCTTTGCCGCCGGGGACGCTTGCTCCCTCCCTGCCCCCTACACGGC GTCCCTCAGGCGCCCCCATTCCGGACCAGCCCTCGGGAGTCGCCGACCCG GCCTCCCGCAAAGACTTTTCCCCAGACCTCGGGCGCACCCCCTGCACGCC GCCTTCATCCCCGGCCTGTCTCCTGAGCCCCCGCGCATCCTAGACCCTTT CTCCTCCAGGAGACGGATCTCTCTCCGACCTGCCACAGATCCCCTATTCA AGACCACCCACCTTCTGGTACCAGATCGCGCCCATCTAGGTTATTTCCGT GGGATACTGAGACACCCCCGGTCCAAGCCTCCCCTCCACCACTGCGCCCT TCTCCCTGAGGACCTCAGCTTTCCCTCGAGGCCCTCCTACCTTTTGCCGG GAGACCCCCAGCCCCTGCAGGGGCGGGGCCTCCCCACCACACCAGCCCTG TTCGCGCTCTCGGCAGTGCCGGGGGGCGCCGCCTCCCCCATGCCGCCCTC CGGGCTGCGGCTGCTGCCGCTGCTGCTACCGCTGCTGTGGCTACTGGTGC TGACGCCTGGCCGGCCGGCCGCGGGACTATCCACCTGCAAGACTATCGAC ATGGAGCTGGTGAAGCGGAAGCGCATCGAGGCCATCCGCGGCCAGATCCT GTCCAAGCTGCGGCTCGCCAGCCCCCCGAGCCAGGGGGAGGTGCCGCCCG GCCCGCTGCCCGAGGCCGTGCTCGCCCTGTACAACAGCACCCGCGACCGG GTGGCCGGGGAGAGTGCAGAACCGGAGCCCGAGCCTGAGGCCGACTACTA CGCCAAGGAGGTCACCCGCGTGCTAATGGTGGAAACCCACAACGAAATCT ATGACAAGTTCAAGCAGAGTACACACAGCATATATATGTTCTTCAACACA TCAGAGCTCCGAGAAGCGGTACCTGAACCCGTGTTGCTCTCCCGGGCAGA GCTGCGTCTGCTGAGGCTCAAGTTAAAAGTGGAGCAGCACGTGGAGCTGT ACCAGAAATACAGCAACAATTCCTGGCGATACCTCAGCAACCGGCTGCTG GCACCCAGCGACTCGCCAGAGTGGTTATCTTTTGATGTCACCGGAGTTGT GCGGCAGTGGTTGAGCCGTGGAGGGGAAATTGAGGGCTTTCGCCTTAGCG CCCACTGCTCCTGTGACAGCAGGGATAACACACTGCAAGTGGACATCAAC GGGTTCACTACCGGCCGCCGAGGTGACCTGGCCACCATTCATGGCATGAA CCGGCCTTTCCTGCTTCTCATGGCCACCCCGCTGGAGAGGGCCCAGCATC TGCAAAGCTCCCGGCACCGCCGAGCCCTGGACACCAACTATTGCTTCAGC TCCACGGAGAAGAACTGCTGCGTGCGGCAGCTGTACATTGACTTCCGCAA GGACCTCGGCTGGAAGTGGATCCACGAGCCCAAGGGCTACCATGCCAACT TCTGCCTCGGGCCCTGCCCCTACATTTGGAGCCTGGACACGCAGTACAGC AAGGTCCTGGCCCTGTACAACCAGCATAACCCGGGCGCCTCGGCGGCGCC GTGCTGCGTGCCGCAGGCGCTGGAGCCGCTGCCCATCGTGTACTACGTGG GCCGCAAGCCCAAGGTGGAGCAGCTGTCCAACATGATCGTGCGCTCCTGC AAGTGCAGCTGAGGTCCCGCCCCGCCCCGCCCCGCCCCGGCAGGCCCGGC CCCACCCCGCCCCGCCCCCGCTGCCTTGCCCATGGGGGCTGTATTTAAGG ACACCCGTGCCCCAAGCCCACCTGGGGCCCCATTAAAGATGGAGAGAGGA CTGCGGATCTCTGTGTCATTGGGCGCCTGCCTGGGGTCTCCATCCCTGAC GTTCCCCCACTCCCACTCCCTCTCTCTCCCTCTCTGCCTCCTCCTGCCTG TCTGCACTATTCCTTTGCCCGGCATCAAGGCACAGGGGACCAGTGGGGAA CACTACTGTAGTTAGATCTATTTATTGAGCACCTTGGGCACTGTTGAAGT GCCTTACATTAATGAACTCATTCAGTCACCATAGCAACACTCTGAGATGC AGGGACTCTGATAACACCCATTTTAAAGGTGAGGAAACAAGCCCAGAGAG GTTAAGGGAGGAGTTCCTGCCCACCAGGAACCTGCTTTAGTGGGGGATAG TGAAGAAGACAATAAAAGATAGTAGTTCAGGCC (NCBI Reference Sequence: NM_000660.5; SEQ ID NO: 16) TGFβ1 protein sequence MPPSGLRLLPLLLPLLWLLVLTPGRPAAGLSTCKTIDMELVKRKRIEAIR GQILSKLRLASPPSQGEVPPGPLPEAVLALYNSTRDRVAGESAEPEPEPE ADYYAKEVTRVLMVETHNEIYDKFKQSTHSIYMFFNTSELREAVPEPVLL SRAELRLLRLKLKVEQHVELYQKYSNNSWRYLSNRLLAPSDSPEWLSFDV TGVVRQWLSRGGEIEGFRLSAHCSCDSRDNTLQVDINGFTTGRRGDLATI HGMNRPFLLLMATPLERAQHLQSSRHRRALDTNYCFSSTEKNCCVRQLYI DFRKDLGWKWIHEPKGYHANFCLGPCPYIWSLDTQYSKVLALYNQHNPGA SAAPCCVPQALEPLPIVYYVGRKPKVEQLSNMIVRSCKCS (NCBI Reference Sequence: NP_000651.3; SEQ ID NO: 17)

In a fourth aspect, the present invention also relates to an in vitro method for predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, from a cancer sample of said cancer patient, comprising:

-   -   a) Measuring in vitro at least the TGFß1 expression level in         said tumor sample;     -   b) Incubating said cancer sample with a composition comprising         SEV expressing NFATC4;     -   c) Measuring in vitro at least the TGFß1 expression level in         said tumor sample incubated with a composition comprising SEV by         cells expressing NFATC4; and     -   d) Predicting efficiency of a treatment with a composition         comprising SEV of cells expressing NFATC4 in said cancer patient         if at least the TGFß1 expression level measured in step c) is         higher than at least the TGFß1 expression level measured in step         a), and predicting non efficiency of a treatment with a         composition comprising SEV of cells expressing NFATC4 in said         cancer patient if at least the TGFß1 expression level measured         in step c) is lower or equal at least to the TGFß1 expression         level measured in step a).

In the method for predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, the ability of SEV of cells expressing NFATC4 to induce or increase TGFß1 expression by cancer cells is tested. An increase in TGFß1 expression by cancer cells after contact with SEV of cells expressing NFATC4 will predict therapeutic efficiency, while stability or decrease in TGFß1 expression by cancer cells after contact with SEV of cells expressing NFATC4 will predict therapeutic inefficiency.

By “cancer sample”, it is meant any sample comprising cancer cells, including but not limited to a cancer biopsy or a complete or partial cancer surgical resection, or a blood sample. Indeed, it is well known in the art that circulating cancer cells are present in blood.

In both above described in vitro methods for determining or predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, the expression level of TGFß1 in the two biological samples of said cancer patient may be measured by any suitable mean.

In a particular embodiment, the expression level of TGFß1 in the two biological samples of said cancer patient may be measured at the nucleic level, by measuring the amount of TGFß1 transcripts. The amount of TGFß1 transcripts can be measured by any technology known by a person skilled in the art. In particular, the measure may be carried out directly on an extracted messenger RNA (mRNA) sample, or on retrotranscribed complementary DNA (cDNA) prepared from extracted mRNA by technologies well-known in the art. From the mRNA or cDNA sample, the amount of nucleic acid transcripts may be measured using any technology known by a person skilled in the art, including nucleic microarrays, quantitative PCR, next generation sequencing and hybridization with a labelled probe.

In particular, real time quantitative RT-PCR (qRT-PCR) may be useful. Commercially available qRT-PCR based methods (e.g., Taqman® Array) may for instance be employed, the design of primers and/or probe being easily made based on the sequences of TGFß1 disclosed in Table 3 above.

Nucleic acid assays or arrays can also be used to assess in vitro the expression level of TGFB1. In some embodiments, a nucleic acid microarray can be prepared or purchased. An array typically contains a solid support and at least one nucleic acid (cDNA or oligonucleotide) contacting the support, where the oligonucleotide corresponds to at least a portion of the target gene. For example, an assay may be in the form of a membrane, a chip, a disk, a test strip, a filter, a microsphere, a multiwell plate, and the like. An assay system may have a solid support on which a nucleic acid (cDNA or oligonucleotide) corresponding to the target gene is attached. The solid support may comprise, for example, a plastic, silicon, a metal, a resin, or a glass. The assay components can be prepared and packaged together as a kit for detecting a gene. To determine the expression profile of a target nucleic sample, said sample is labelled, contacted with the microarray in hybridization conditions, leading to the formation of complexes between target nucleic acids that are complementary to probe sequences attached to the microarray surface. The presence of labelled hybridized complexes is then detected. Many variants of the microarray hybridization technology are available to the person skilled in the art.

In another particular embodiment, the expression level of TGFß1 in the two biological samples of said cancer patient may be measured at the protein level. For instance, at the protein level, the in vitro measure of the expression level of TGFß1 may be performed by any dosage method known by a person skilled in the art, including but not limited to ELISA or mass spectrometry analysis. These technologies are easily adapted to any fluid or solid sample. Indeed, proteins of the fluid or solid sample may be extracted using various technologies well known to those skilled in the art for measure by ELISA or mass spectrometry in solution. Alternatively, the expression level of a protein in a biological sample may be analyzed by using mass spectrometry directly on the tissue slice. For determination of TGFß1 expression at the protein level, ELISA is a preferred technology.

In both above described in vitro methods for determining or predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, the tested patient may be suffering from any type of cancer, as described above.

This is particularly true for the above described in vitro methods for determining the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient, which does not necessitate to put a cancer sample into culture. In this context, the cancer from which suffers the patient to be tested may notably be selected from solid cancers; preferably from carcinomas and brain cancers, more preferably from breast carcinoma, melanoma, pancreatic carcinoma, colorectal carcinoma, lung carcinoma, and glioblastoma; even more preferably said cancer is selected from breast carcinoma, melanoma, pancreatic carcinoma, and glioblastoma, most preferably said cancer is breast carcinoma, in particular metastatic breast carcinoma.

While the above method for predicting the therapeutic efficiency of a treatment with a composition comprising SEV of cells expressing NFATC4 in a cancer patient may be applied to any type of cancer, it is preferably applied to patients suffering from liquid cancers, such as leukemia or lymphoma. Indeed, liquid cancer samples are more easily put into culture for measure of TGFß1 expression before and after contact with SEV of cells expressing NFATC4.

The following examples merely intend to illustrate the present invention.

EXAMPLES Example 1: SEV Produced by Low Invasive Breast Cancer Cells Inhibit Cancer Progression and Metastasis

Materials and Methods

Cell Culture

The MDA-MB-231, T-47D, MCF7, NIH3T3, HEK293T cell lines were from the American Type Culture Collection, The SUM-159-PT cell line was provided by Alex Toker (Harvard Medical School), MDA-MB-231 D3H2 LN-Luc and 4T1-Red-FLuc cell lines were from Perkin Elmer. MDA-MB-231 D3H2 LN-Luc cell line was maintained in Eagle's MEM, 75 μg/ml Zeocin. 4T1-Red-FLuc cell line was in RPMI 1640, 10% Foetal Calf Serum. MDA-MB-231 and SUM-159-PT cells were maintained in Dulbecco Modified Eagle Medium (DMEM), low glucose (1 g/L D-glucose), 10% Foetal Calf Serum. T-47D and MCF7 were maintained in RPMI 1640, 10% Foetal Calf Serum. NIH-3T3 cells were in Dulbecco Modified Eagle Medium (DMEM), High glucose (4.5 g/L D-glucose), 10% Newborn Calf Serum. The HEK293T cell line was maintained in Dulbecco Modified Eagle Medium (DMEM), High glucose (4.5 g/L D-glucose), 10% Foetal Calf Serum. All media were supplemented with 2 mM L-Glutamine, 100 U/mL Penicillin and 100 μg/mL Streptomycin.

SEV Production

Preparation of SEV Depleted Medium

For media containing animal driven components (e.g. serum), SEV depletion of the medium should be conducted.

1. Prepare medium with up to 20% serum (higher serum concentration is not recommended).

2. Precool the ultracentrifuge and rotor to 4° c.

-   -   For SW32Ti rotor:     -   i. Use pollyallomer 38.5 ml tubes (326823). Fill each with 38 ml         medium and balance by weight (aim for 0.01-0.02 gr differences).     -   ii. Spin overnight (for standardization—18 hours) at 4° c. at         30,000 RPM.     -   For Type 45Ti:     -   i. Use 65 ml reusable tubes labeled for depletion. Fill each         with 65 ml medium and balance by weight (aim for 0.01-0.02 gr         differences).     -   ii. Spin overnight (for standardization—15 hours) at 4° c. at         38,000 RPM.

3. Take supernatant carefully, do not disturb the pellet.

4. Filter 0.22 μm and save at 4° c. Use within 1 week.

Medium Change

Grow cells as optimized for SEV production for the cell type, change to SEV depleted in the time point specified.

1. Prepare medium from SEV depleted medium, dilute if necessary.

2. Vacuum medium.

3. For 150 mm dish, add 7 ml PBS.

4. Vacuum well all PBS or medium left.

5. Add SEV depleted medium.

SEV Production

Grow cells as optimized for SEV production for the cell type, change to SEV depleted medium if necessary and conduct the SEV isolation at the time point indicated (typically 24-48 hours after medium change).

Note: Cells should be in good condition—cell death and apoptotic bodies could lead to contamination of SEV pellet.

If SEV are to be used for functional assays, conduct in sterile conditions.

Precool ultracentrifuge with rotor Type 45Ti (this rotor takes a long time to cool, it is better to leave it on the fridge the night before starting the production).

1. Pass medium from dishes to 50 ml tubes.

2. Spin 1350 RPM for 10 minutes at 4° c.

In parallel: For a representative number of dishes (typically—3 for a 30 dishes production):

a. Wash with PBS and vacuum

b. Add trypsin, incubate 37° c. until detachment

c. Add medium with 10% serum, preferably SEV depleted

d. Count cells from each dish separately and keep record of total cells used for production.

e. Add cold PBS

f. Centrifuge 1350 RPM for 7 minutes at 4° c.

g. Vacuum supernatant

h. Freeze −80° c. for protein/RNA.

3. Pass supernatant carefully to new 50 ml tubes. Discard tubes with pellet.

4. Spin 3500 RPM in culture room) for 20 minutes at 4° c.

5. Pass supernatant carefully to new 50 ml tubes. Discard tubes with pellet.

6. In centrifuge 5810R rotor F-34-6-38: Spin 10,000 RPM for 30 minutes at 4° c.

7. Pass supernatant carefully to sterile ultracentrifuge tubes for rotor Type 45 Ti (tubes 355622). Look carefully that tubes are not cracked. Fill tubes with 65 ml and balance by weight (aim for 0.01-0.02 gr differences). Mark the tube in the side close to rotor in order to mark pellet location.

At this step the medium can be kept in 4° c. for a few days (max 3-4) before ultracentrifugation.

8. Ultracentrifuge 40,000 RPM for 90 minutes at 4° c.

9. Carefully, as far as possible from pellet location—discard supernatant, leaving the minimal volume possible (if you can see the pellet, aspirate completely, if not, leave max 2 mL medium).

10. Using a p1000, resuspend the pellet in 2 mL cold PBS (or the remaining supernatant) and pass to another tube.

11. Add 2 ml cold PBS and wash with p1000, taking care to wash carefully the marked pellet location. Pass to the same tube.

12. Repeat wash with 2 ml PBS and pass to the same tube.

13. Repeat for all tubes, passing all to the same tube.

14. Fill tube to 65 ml with cold PBS and balance weight.

15. Ultracentrifuge 40,000 RPM for 90 minutes at 4° c.

16. Carefully, as far as possible from pellet location—discard supernatant, leaving the minimal volume possible.

17. Resuspend in remaining supernatant or add cold PBS in minimal amount to resuspend (this will depend on amount of cells used and cell type). Take care to wash carefully the marked pellet location. Pass to a sterilized siliconized tube (sigma T3281).

18. Wash tube, especially pellet location, with minimal amount of cold PBS. Pass to same siliconized tube.

19. Measure final volume and keep record.

20. Aliquot into sterile siliconized tubes and keep at −80° c.

Important Observations:

For MDA-MB 231 and SUM 159 PT cells: seed 1×10E6 cells per 150 mm diameter dish; 3 days later change the medium to SEV depleted; 2 days later start the production;

For T47-D cells: seed 6×10E6 cells per 150 mm diameter dish; 5 days later change the medium to SEV depleted; 2 days later start the production;

For MCF7 cells: seed 7×10E6 cells per 150 mm diameter dish; 5 days later change the medium to SEV depleted; 2 days later start the production;

When using 150 mm diameter dish, keep cells in 25 mL medium;

For all of the cell types listed above, a visible pellet is obtained even after the 1st ultra-centrifugation, so it is important to eliminate all supernatant both after the 1st ultra and after the PBS wash to avoid contamination with proteins that could still be in suspension in the supernatant;

SEV depleted RPMI and DMEM are prepared with 20% serum; 1% P/S (and l-glu, in the case of RPMI). The medium is filtered after the ON ultracentrifugation and can be kept in the fridge up to 1 month. When diluting 20% SEV depleted medium before changing cell medium for production, a new bottle of fresh medium should be used. The diluted medium should be re-filtered upon dilution before changing the cell medium for the production.

Antibodies and Reagents

The following antibodies were used: Anti-CD63(#clone H5C6, BD Biosciences), anti-NFAT3 (Sigma; #F1804, Thermo Scientific; #PA1-021, Santa-Cruz Biotechnology; sc-13036), anti-CD9 (#clone CBL162, Millipore), anti-Actin (Thermo Scientific; #MA5-15739), ESR1 (Santa-Cruz Biotechnology; sc-543).

Recombinant TGFß1 was from Invitrogen (#PHG9214)

SEV Characterization

Size distribution of SEV was evaluated by NanoSight.

Western Blot

400 000 T47D or MDA-MB-231 cell were used per lane in laemelli buffer. 20 ug of each SEV were used per lane in Laemelli buffer+2% SDS. Samples were boiled for 30 mins at 95° C. before loading on the gel.Gel was transferred on nitrocellulose membrane and blocked 1 h in TBS-0.05% Tween-20 at room temperature. Then membrane were incubated with the different antibodies depicted on the figure overnight. The following day membrane was washed 4 time in TBS-0.05% Tween-20 and incubate for 1 h at room temperature with horseradish-peroxydase-coupled secondary antibodies. Then the membrane was washed 4 time in TBS-0.05% Tween-20 and incubate for 1 h at room temperature and reveled with ECL to visualise the proteins.

Invasion Assays

The invasion assays were performed essentially as described, using Transwell chambers (Becton Dickinson) with 8-μm pore membranes coated with Matrigel (Becton Dickinson). Cells, non-transfected or transfected with the relevant siRNA, were starved by 4 washes during the day with medium where 10% Foetal Calf Serum was omitted, after the last wash the cells 600 ul of medium without 10% Foetal Calf Serum. The following day cell were treated with either PBS or 0.375.10⁹ particles/well in a 12 well plate for 24 h. In some cases, 5 ng/mL recombinant hTGFβ1 (#PHG9214, Invitrogen) or vehicle was added. The following day cell were trypsinized and harvested in serum-free medium containing 0.1% BSA, and cells were added to each well. Conditioned NIH-3T3 medium was added to the bottom wells of the chambers. After 6 hours, cells that had not invaded were removed from the upper face of the filters using cotton swabs, and cells that had invaded to the lower surface of the filters were fixed for 10 min in 100% methanol and then stained with crystal violet for 30 min. All cells in each Transwell were counted. The numbers of cells that invaded in each condition were compared with the PBS condition arbitrary set as a ratio of 1. When the assay was performed with cells transiently transfected by siRNA, cells were stained with crystal violet since 95% of the cells were effectively transfected. In some cases, 5 ng/mL recombinant TWEAK was added for 6 hours to the cells during the assay.

Proliferation and Apoptosis Assays

Apoptosis Test

Highly invasive MDA-MB-231 (A) were treated for 24 h and SUM-159-PT (B) for 24, with the indicated amount of SEV from T47D-WT to evaluate cell apoptosis. 24 h after SEV treatment, cell supernatant was removed and cells were trypsinized and washed twice in cold PBS. Cells were resuspended cells in cold binding buffer (10 mM HEPES pH 7.4, 140 mM NaCl, 2.5 mM CaCl2, 0.1% BSA) to a concentration of 1.10⁶ cells/mL. Then 100 μL of cells (1×105 to 1×106) was added in polypropylene FACS tubes and 10 μL of labelled Annexin V was added to the cells. Cell were incubated for 15 minutes on ice, protected from light. Then, without washing, 380 μL of cold 1× binding buffer waw added to each tube and annexin-V labelling was immediately analysed by flow cytometry to evaluated apoptosis.

Proliferation Test

Highly invasive MDA-MB-231 (A) were treated for 24 h and SUM-159-PT (B) for 24, 48 and 72 h with the indicated amount of SEV from T47D-WT to evaluate cell proliferation. MDA-MB-231 proliferation was evaluated by a BrdU Incorporation assay following the manufacturer recommendations (Roche: #11444611001).

shRNA All shRNA were from Dharmacon cloned in the pGIPZ lentiviral vector. pGIPZ sh(hNFAT3)-3 5′-CAATGAACACCACCTTGGA-3′ (clone ID: V3LHS_383428, SEQ ID NO: 18) pGIPZ sh(hNFAT3) 4 5′- AGTCTCAGGGAACATCCGC-3′ (clone ID: V3LHS_383431, SEQ ID NO: 19) pGIPZ sh(hTGFB1) 1 5′- ATGCTGTGTGTACTCTGCT-3′ (clone ID: V3LHS_356824, SEQ ID NO: 20) pGIPZ sh(hTGFB1) 2 5′- TGATGTCCACTTGCAGTGT-3′ (clone ID: V3LHS_356823, SEQ ID NO:21)

Production of shRNA Lentiviral Particles in HEK293T Cells

-   -   DAY 1:     -   Plate cells in 10% SVF/HIGH DMEM

Cells number Volume medium 100 cm2 3.5 · 10⁶ 14 ml

-   -   DAY 2:     -   1—Plasmids transfection by phosphate calcium

Lentiviral Transfer Trans-Lentiviral Total Volume Vector shRNA Packaging Mix (with sterile water) 100 cm2 42 ug 30 ul 945 ul

-   -   2—Add the indicated volume of CaCl2 to the diluted DNA above

CaCl2 100 cm2 15 ul

-   -   3—Vortex the tube at a speed sufficient to thoroughly mix         reagents without spillover. While vortexing, add drop-wise the         indicated volume of 2× HBSS:

2x HBSS 100 cm2 1050 ul

-   -   4—Incubate at room temperature for 3 minutes. A light chalky         precipitate should appear during this incubation (the         precipitate may not always be obvious).     -   5—Add the total volume (300 μL or 2.1 mL) of transfection mix         drop-wise to the cells.     -   (Note: The exact volume may be slightly less due to pipetting         loss, but this will not negatively impact transfection         effciency.)     -   6—Incubate cells at 37° C. with 5% CO2 for 10-16 hours     -   DAY 3:     -   1—Prepare reduced serum medium:         -   a. High Glucose DMEM         -   b. 5% Fetal Bovine         -   c. 2 mM L-glutamine         -   d. 1× Penicillin/Streptomycin     -   2—Remove calcium phosphate-containing medium from cells and         replace 14 ml of reduced serum medium.     -   3—Incubate cells at 37° C. with 5% CO2 for an additional 48         hours.     -   DAY 5: Viral Particle Collection and Concentration     -   1—Harvest viral particle-containing supernatants 48 hours after         the medium change by removing medium to a 15 mL sterile, capped,         conical tube.     -   2—Pellet non-adherent cells and debris by centrifugation at         1600×g at 4° C. for 10 minutes to pellet cell debris.     -   3—Filtration step in which the supernatant is passed through a         sterile, 0.22-0.45 μM low protein binding filter after the         low-speed centrifugation step to remove any remaining cellular         debris. Filtered viral medium is directly put in         ultracentrifugation tube.     -   4—Concentrate by ultracentrifugation in a swinging-bucket         ultracentrifuge rotor. Transfer the altered supernatant to a         sterile ultracentrifuge tube. Bring volume to almost fill the         tube to avoid braking tube during the ultra-centrifugation with         DMEM containing no serum. For an SW28 rotor, centrifuge at         23,000 rpm for 2 hours at 4° C.     -   5—Pipette the desired resuspension volume of DMEM (no serum)         onto the pellet at the bottom of the tube.     -   6—The visible pellet (if visible) is made up mostly of serum         proteins from the culture media of the transfected cells. The         viral particles need to be dislodged from this protein pellet.         After adding the DMEM to the pellet, incubate for 10 minutes at         4° C. Then gently pipette up and down about 30 times, avoiding         the formation of bubbles.     -   7—Transfer the resuspended pellet to a sterile microfuge tube         and centrifuge at full speed for 3-4 minutes. This         centrifugation will pellet the serum proteins, which adhere to         the bottom of the tube. After centrifugation, transfer the         supernatant to a new microfuge tube and aresuspend in 100 ul pf         PBS (20 ul will be used per infection. Always store lentiviral         particles at −80° C.

Infection of Cells with Lentiviral Particules and Selection

-   -   DAY 1:     -   Plate cells in 24 well plates in 10% SVF+AB in their         corresponding medium

Cell type Cells number Volume medium MDA-MB-231 2.5 · 10⁵ 1 ml DMEM low SUM-159PT 1.5 · 10⁵ 1 ml DMEM low MDA-MB-231 D3H2LN 2.5 · 10⁵ 1 ml MEM + sodum pyruvate + ZEOCINE 75 ug/ml T47D  3 · 10⁵ 1 ml RPMI MCF7  3 · 10⁵ 1 ml RPMI

-   -   DAY 2:     -   1. Replace the medium with 250 ul of the corresponding medium         complemented with 4 ug/ml Polybrene     -   2. Infect by adding directly on the cells 20 ul of the virus     -   3. Let in the incubator for 4 h     -   4. After 4 h, add 1 ml/well of the corresponding medium         complemented with polybrene     -   DAY 6:     -   1. Trypsinysed the cell to transfer them in a 25 cm flask     -   DAY 9:     -   1. Bring the cell back in the lab and tranfer them in:

Cell type Flask MDA-MB-231 150 cm SUM-159PT 150 cm MDA-MB-231 D3H2LN 150 cm T47D  75 cm MCF7  75 cm

-   -   When the flask is confluent you can proceed to the sorting of         FACS     -   CELL SORTING:     -   You should have a concentration for the sorting of 10. 10⁶         cells/ml     -   1. Trypsinize the cell and count them     -   2. Wash the cell one time in PBS     -   3. Resuspend the cell in the required volume of PBS completed         with 2× AB     -   4. Pass the cell on a cell strainer to eliminate aggregate     -   5. Transfert the cell Polypropylene Facs tubes     -   6. Prepare tube to receive the sorted cells containing 100% SVF         completed with 2× AB     -   7. Prepare 6 well plate to grow the sorted cells containing the         corresponding medium without SVF but with 2× AB (when the sorted         cells will be added there will be 20% SVF final)     -   8. Then let the cells grow until there is enough to realize the         different validation tests.     -   9. Don't forget to frost the clone.

siRNA

All siRNA were on Target plus smartpool from Dharmacon

For human TGF□1, the siRNA were:

(SEQ ID NO: 22) siRNA1 5′- AUUGAGGGCUUUCGCUUA-3′, (SEQ ID NO: 23) siRNA2 5′- CCGAGAAGCGGUACCUGAA-3′, (SEQ ID NO: 24) siRNA3 5′- GCAGAGUACACAGCAUA-3′, (SEQ ID NO: 25) siRNA4 5′- GGACUAUCCACCUGCAAGA-3′,

siRNA control was a validated non targeting smartpool from Dharmacon. Sequence was not provided by the manufacturer (reference Dharmacon: D-001810-02-20)

To transiently silence human TGFβ1, we used the specific siRNAs described above at 30 nM, and transfected cells with DharmaFECT for 48 hr according to the manufacturer's instructions. Effective downregulation of endogenous TGFβ1 was verified by ELISA.

ELISA for Human TGFβ1

In Cell Supernatant

The ELISA for TGFβ1 was performed as directed by the manufacturer on 100 μl of activated cell supernatants using a kit from R&D systems (#DY240)

In Mouse Serum

Blood was collected from mice and serum separation was achieved on BD Microtainer SSR Tubes (#365968). The ELISA for TGFβ1 was performed as directed by the manufacturer on 1 μl of activated serum using a kit from R&D systems (#DY240)

Plasmids Construction

The human TGFβ1 promoter (PGL3-hTGFß1-1670) was cloned by PCR using as a template genomic DNA isolated from MDA-MB-231 in the PGL3 basic vector (Promega). All constructions were verified by sequencing. The pCS2-(n)-βgal has been already described (Jauliac, S et al. (2002). Nature Cell Biology, 4(7), 540-544).

Cells were transiently transfected with the appropriate plasmids using Lipofectamine 2000 (Invitrogen) according to the manufacturer's instructions.

Sequences of the Different Constructions:

-   -   PGL3 basic (Promega, empty vector): SEQ ID NO:26;     -   PGL3-hTGFß1-1670 promoter (expression of luciferase under         control of hTGFß1 promoter): SEQ ID NO:27;

Luciferase Assay

Cells were cotransfected with either the PGL3 basic plasmid or the PGL3-hTGFß1-1670 Luciferase promoter construct and the pCS2-(n)-ß-galactosidase plasmid using Lipofectamine 2000. The following day cell were treated with either PBS or 1.10⁹ particles/well in a 6 well plate for 24 h. After 24 h cell were lysed with the Reporter Lysis Buffer (Promega) and Luciferase and ß-gal activities were measured using the Luciferase Assay System (Promega) and Galacton-plus (Tropix) on a luminometer. Luciferase activities were normalized relative to the corresponding ß-gal activities.

Mice Experiments:

Xenograft and Follow-Up In Vivo

-   -   For MB-231 D3H2 LN-Luc in Hsd:AthymicNude-Foxn1nu female Mice

6 weeks old Hsd:AthymicNude-Foxn1nu female Mice were from Envigo company. Mice were hosted during 1 week in the IUH animal facility before any manipulation. When mice reached 7 weeks old, 1 to 0.5.10⁶ MDA-MB-231 D3H2 LN-Luc cells diluted in 100 μl of PBS were injected in the 2nd lower right fat-pad. 3 days later successful xeno-tranplantations were vizualised by luminescence by injecting XenoLight D-Luciferin, Potassium Salt diluted in PBS and luminescence was acquired for 30 s on the Xenogen system. Groups of 8 mice for each condition were established with equivalent luminescence. Experiments take place during 2 months. The first month, tumour size was measured by caliper on Monday and Thursday. The Tuesday of each week, mice were injected weekly with 50.10⁸ SEV T47D-WT, T47D-shCtrl, T47D-shNFAT3-3 or T47D-shNFAT3-4, either intratumoral or intravenous during 2 months as described in the different experiment. The Friday of each week blood was collected retro-orbitally. Beginning the 2n^(d) month, metastases begin to appear, therefore evaluation of metastases formation was done on Monday and Thursday when tumor size was measured. Mice were injected with XenoLight D-Luciferin, Potassium Salt diluted in PBS and bioluminescent images (where the primary tumor was shield with a black tissue) were acquired on the Xenogen system to quantify the mean photon flux produced by the metastatic MDA-MB-231 D3H2 LN-Luc cells. Metastases quantification is presented as the mean photon flux produced by the metastatic MDA-MB-231 D3H2 LN-Luc cells. At the end of the 2 months, mice were sacrificed and primary tumours and lungs, axillary lymph nodes and liver were keep at −80° C. for future immunofluorescence labelling.

Results

Characterization of SEV Produced by Low Invasive Breast Cancer T47D and MCF7 Cells

Representative examples of size distribution of SEV produced by MDA-MB-231 and T47D cells are represented in FIG. 1A (MDA-MB-231) and FIG. 1B (T47D) and show that SEV produced by MDA-MB-231 and T47D cells have a similar mean size between 100 and 200 nm.

SEV produced by MDA-MB-231 and T47D cells were also characterized by Western blot and compared to whole cell extracts using antibodies against Calnexin; CD63 and CD81 (FIG. 1C). Results show that the purified sample contains only SEV because it expresses CD63 marker and not calnexin, showing that no cells are present in said sample.

SEV Produced by Low Invasive Breast Cancer T47D-WT and MCF7-WT Cells Inhibit Specifically Invasion of Highly Invasive MDA-MB-231 and SUM-159-PT Breast Cancer Cells and WM.266.4 Melanoma Cells.

SEV from different cell lines were produced with the intent to test their specific capacity to modulate invasion of highly invasive breast cancer cells (MDA-MB-231, SUM159PT) or melanoma cells (WM.266.4) in classical transwell invasion assays. Five types of cells were chosen for the production of SEV: 2 low invasive breast cancer cell lines (T47D-WT, MCF7), 1 highly invasive breast cancer cell line (MDA-MB-231), and 2 human fibroblasts obtained from young and old humans biopsies (FHN21-WT, 20 years old; FHN32-WT, 74 years old). Results are presented in FIG. 2 and show that:

-   -   SEV produced by human fibroblasts obtained from young and old         humans biopsies (FHN21-WT and FHN32-WT) and by a highly invasive         breast cancer cell line (MDA-MB-231) do not significantly alter         the invasion index of highly invasive breast cancer cell line         MDA-MB-231 (see FIG. 2A);     -   SEV produced by 2 low invasive breast cancer cell lines, T47D-WT         and MCF7-WT cells, significantly decrease by about 50% the         invasion index of highly invasive breast cancer cell lines         MDA-MB-231 (see FIGS. 2A and 2C) and SUM-159-PT (see FIG. 2D).         The fact that two distinct low invasive breast cancer cell lines         have the same effect highlights that the inhibitory effect of         SEV produced by low invasive breast cancer cell lines is not         specific toward an SEV-producing cell line but is a general         effect;     -   SEV produced by low invasive breast cancer cell lines T47D-WT         and MCF7-WT cells also significantly decrease by about 60% the         invasion index of highly invasive melanoma cell line WM.266.4         (see FIG. 2B). The fact that the two low invasive breast cancer         cell lines have the same effect on a highly invasive melanoma         cell line highlights that the inhibitory effect of SEV produced         by low invasive breast cancer cell lines is not specific toward         highly invasive breast cancer cell lines, but is a general         effect against highly invasive cell lines, no matter what is         their original cell type.

SEV from Low Invasive Breast Cancer Cells (T47D-WT) Do Not Modify the Proliferation of Highly Invasive Breast Cancer Cells (MDA-MB-231 and SUM-159-PT)

The ability of SEV from low invasive breast cancer cell line T47D-WT to alter the proliferation of highly invasive breast cancer cell lines MDA-MB-231 and SUM159PT was further assessed, as well as their ability to induce apoptosis of highly invasive breast cancer cell line MDA-MB-231.

Results are presented in FIG. 3 and show that SEV from low invasive breast cancer cell line T47D-WT do not modify the proliferation of highly invasive breast cancer cell lines MDA-MB-231 (see FIG. 3A) and SUM159PT(see FIG. 3B), and do not induce apoptosis of highly invasive breast cancer cell line MDA-MB-231.

The Inhibitory Effect of SEV Produced by Low Invasive Breast Cancer Cell Line T47D on the Invasive Capacity of Highly Invasive Cell Lines (MDA-MB-231 and SUM-159-PT) Requires the Expression of NFAT3 in the Low Invasive SEV-Producing Cell Line T47D-WT

The inventors had previously shown that low invasive breast cancer cell lines express specifically high amount of NFAT3 compared to the high invasive breast cancer cell lines required to their low invasive capacity (Fougère, M., et al. (2010). Oncogene, 29(15), 2292-2301).

Therefore, the hypothesis was made that endogenous NFAT3 in SEV-producing cells (T47D-WT) could be required for these SEV to blunt cell invasion of high invasive cell line. To test this possibility, they generated T47D cells where endogenous NFAT3 expression was reduced by 2 shRNA that reduce to 50% the expression of endogenous NFAT3 (ShNFAT3-3, ShNFAT3-4) or unaltered by a shRNA control (shCtrl) (see FIG. 4A). SEV were produced from the shRNA expressing T47D-cell lines and tested on the invasive capacity of highly invasive cell lines MDA-MB-231 and SUM-159-PT.

Results are presented in FIG. 4B and FIG. 4C and demonstrate that expression of endogenous NFAT3 in SEV-T47D-producing cell line is absolutely required to impede breast cancer cell invasion, since SEV produced from T47D-cell lines expressing shRNA that reduce to 50% the expression of endogenous NFAT3 (ShNFAT3-3, ShNFAT3-4) do not decrease the invasion index of highly invasive cell lines MDA-MB-231 and SUM-159-PT, contrary to SEV produced from T47D-cell lines without shRNA (T47D-WT) or expressing a control shRNA (shCtrl).

These data show for the first time that NFAT3 expression in SEV producing cell line is key to the transfer the invasive inhibitory capacity to high invasive cell lines.

De Novo Induction of TGFβ1 in MDA-MB-231 Cells is Required for the SEV to Modulate Breast Cancer Cell Invasion.

To begin to elucidate by which mechanisms SEV produced by the T47D-WT cell line can impede invasion of highly invasive breast cancer cell lines, the modulation of different factors by SEV in the receiving cells (MDA-MB-231) was evaluate.

Data presented in FIG. 5A show that SEV from T47D-WT cells induce an increase of TGFβ1 secretion in MDA-MB-231. Moreover, this increase of TGFβ1 secretion required an active transcription since pre-treatment of the cells with an inhibitor of transcription (Actinomycin) prevents completely this increase of secretion. These results are critical because they demonstrate that the increase of TGFβ1 secretion is an active mechanism taking place in the receiving cells (MDA-MB-231) and not linked to a contribution of potential SEV TGFß1 protein.

The possibility that this increase of TGFβ1 secretion could be required for SEV to inhibit cell invasion was then tested. For this purpose, endogenous TGFβ1 was independently down regulated, in transient transfection assays, in receiving cells (MDA-MB-231) by an siRNA directed against TGFβ1 (siTGFß1) or a control siRNA (siCtrl). To rescue the loss of endogenous TGFβ1, the receiving cells were treated with exogenous TGFβ1. Results presented in FIG. 5B demonstrate that the increase in TGFβ1 secretion by SEV is absolutely required to inhibit cell invasion since, when TGFβ1 is down-regulated, SEV are no longer able to impede cell invasion (siTGFB1, +SEV) compared to the receiving shCtrl-cells (siCtrl, +SEV). Moreover, adding back exogenous TGFβ1 with SEV is sufficient to restore the capacity of SEV to inhibit cell invasion (siTGFB1, +SEV, +TGFβ1). Furthermore, adding exogenous TGFβ1 without having previously down regulated endogenous TGFb1 (siCtrl, +/−SEV, +TGFb1) is not sufficient to inhibit invasion, showing that treatment with exogenous TGFb1 alone is not enough to inhibit cell invasion. These results demonstrate that SEV from low invasive cell lines induce a transcriptional increase of TGFβ1 secretion in the receiving highly invasive cell line, which is absolutely required for the capacity of SEV to inhibit invasion.

SEV Produced by T47D-WT Cells are Competent in Up-Regulating the Activity of the hTGFB1 Promoter.

A schematic representation of the hTGFb1 promoter is presented in FIG. 6A. Six potential NFAT-binding sites have been found using the NFAT binding site determined using the software available at http://www.fast-db.com/perUnfat.pl. Positions relative to the +1 initiation site are indicated.

It was thus tested if SEV produced by T47D-WT cells are able to up-regulate the activity of the hTGFB1 promoter. Results are presented in FIG. 6B and show that SEV produced by T47D-WT cells do indeed up-regulate the activity of the hTGFB1 promoter.

Intravenous or Intratumoral Injection of SEV Produced by Low Invasive Breast Cancer Cell Line T47D-WT Inhibit Tumor Growth and Metastases Apparition and Correlate with an Induction of TGFβ1

It was then tested if SEV produced by low invasive breast cancer cells could induce the same inhibitory effect in in vivo model as they did in vitro. For this purpose, MDA-MB-231 cells expressing the luciferase gene (D3H2LN) were injected into the left Fat Pad of 6-week-old female mouse Athymic Nude-Foxn1nu mice. SEV produced by low invasive breast cancer cell line T47D-WT or as a control PBS were injected weekly either in the tail vein or in the tumor, one week after xenotransplation of cells.

Monitoring of tumor growth was done by caliper measuring during 10 weeks.

Results are presented in FIG. 7 for intravenous injection and in FIG. 8 for intratumoral injection and show for the first time, and despite the absence of inhibition of cell proliferation in vitro (FIG. 3), that SEV from T47D-WT cells were able to significantly impede tumor growth (intravenous: FIG. 7A, mice N° 610; intratumoral: FIG. 8A, mice N° 614) in vivo compared to the mice injected with PBS (intravenous: FIG. 7A mice N° 629; intratumoral: FIG. 8A, mice N° 617).

Interestingly, in both injection types (intravenous or intratumoral) the inhibitory effect of SEV was closely correlated with an induction of TGFβ1 in the blood of treated mice. Indeed, mice in which the weekly injection of SEV did not modify the tumor growth rate did not show any increase of TGFβ1 in the blood (intravenous: FIG. 7B mice N° 625; intratumoral: FIG. 8B mice N° 602) compared to the mice injected with PBS (intravenous: FIG. 7B mice N° 629; intratumoral: FIG. 8B mice N° 617).

In the same group of mice, metastases formation was evaluated by bioluminescent imaging from day 42 (where the primary tumor was shield with a black tissue), on the Xenogen system, by the mean photon flux produced by the metastatic MDA-MB-231 cells. Results presented in FIG. 7 for intravenous injection and in FIG. 8 for intratumoral injection show for the first time that mice injected with SEV from T47D-WT cells have a significantly reduced unveiling and growth of metastases (intravenous: FIG. 7C, mice N° 610; intratumoral: FIG. 8C, mice N° 614) compared to mice injected with PBS (intravenous: FIG. 7C mice N° 629; intratumoral: FIG. 8C, mice N° 617) either in the tail vein or in the tumor.

Moreover, as shown for tumor growth, the inhibitory effect of SEV on metastases was closely correlated with an induction of TGFβ1 in the blood. Indeed, mice in which the weekly injection of SEV did not modify the metastases apparition did not show any increase of TGFβ1 in the blood (intravenous: FIG. 7D mice N° 625; intratumoral: FIG. 8D mice N° 602) compared to the mice injected with PBS (intravenous: FIG. 7D mice N° 629; intratumoral: FIG. 8D mice N° 617).

These results are critical and demonstrate for the first time that SEV from low invasive breast cancer cells are able to impede tumor growth and metastases apparition in vivo and closely correlate with an increase of TGFβ1 in the blood circulation. This increase of TGFβ1 could be a good tool to evaluate the efficiency of SEV injection in cancer patients.

The inhibitory effect on the tumor growth of the intratumoral injection of SEV requires the expression of NFAT3 in the T47D-SEV producing cells and correlates with induction of TGFβ1.

It was then tested if SEV produced by low invasive breast cancer cells, in which endogenous NFAT3 was down-regulated by shRNA, could induce the same inhibitory effect in in vivo model.

For this purpose, MDA-MB-231 cells expressing the luciferase gene (D3H2LN) were injected into the left Fat Pad of 6-week-old female mouse Athymic Nude-Foxn1nu mice. SEV produced by T47D cells transfected by an shRNA that reduces to 50% the expression of endogenous NFAT3 (ShNFAT3-3, ShNFAT3-4) or by a shRNA control (shCtrl), or as a control PBS were injected in the tumor weekly, one week after xenotransplation of cells. Monitoring of tumor growth was done by caliper measuring during 10 weeks. Results presented in FIG. 9A show for the first time that, despite the absence of inhibition of cell proliferation in vitro, SEV from T47D-shCtrl cells were able to impede significantly tumor growth in vivo compared to the mice injected with PBS (around 50% diminution). Moreover, when endogenous NFAT3 was down regulated in SEV-producing cells (T47D-shNFAT3-3, T47D-shNFAT3-4), then their respective SEV were no longer able to inhibit tumor growth and growth rates were identical to the control mice treated with PBS (see FIG. 9A).

These results are critical and demonstrate for the first time that SEV from low invasive breast cancer cells require the expression of endogenous NFAT3 in the SEV producing cells to impede tumor growth in vivo.

In the same group of mice, metastases formation was evaluated by bioluminescent imaging (where the primary tumor was shield with a black tissue), on the Xenogen system, by the mean photon flux produced by the metastatic MDA-MB-231 cells. Results presented in FIG. 9B show that mice injected with SEV from T47D-shCtrl have a significantly reduced unveiling and growth of metastases compared to the mice injected with PBS. Moreover, when endogenous NFAT3 was down regulated in SEV-producing cells (T47D-shNFAT3-3, T47D-shNFAT3-4), then their respective SEV no longer impeded metastases formation and unveiling and growth rates were identical to the control mice treated with PBS (see FIG. 9B).

These results extend the in vitro data we obtained and demonstrate for the first time that SEV from low invasive breast cancer are able to impede metastases formation in vivo and require the expression of endogenous NFAT3 in the SEV producing cells.

Moreover, the anticancer effect of SEV from T47D-shCtrl cells was once more found to be correlated to an increase in TGFβ1 mean serum concentration (see FIGS. 9C and 9D).

Intravenous or Intratumoral Injection of SEV Produced by Low Invasive Breast Cancer Cell Line T47D-WT Inhibit Tumor Growth and Metastases Apparition Once Tumor is Settled.

To mimic clinical condition, it was then tested if SEV produced by low invasive breast cancer cells, could induce the same inhibitory effect in in vivo model after tumour establishment. For this purpose, MDA-MB-231 cells expressing the luciferase gene (D3H2LN) were injected into the left Fat Pad of 6-week-old female mouse Athymic Nude-Foxn1nu mice. SEV produced by T47D cells were first injected at D27 after D3H2LN injection. Monitoring of tumor growth was done by caliper measuring during 5 weeks after SEV injection. Results presented in FIGS. 10A and B show for the first time that, whatever the administration route (intravenous or intra-tumoural) and despite the absence of inhibition of cell proliferation in vitro, SEV from T47D cells were able to impede significantly tumor growth in vivo 27 days after tumour establishment compared to the mice injected with PBS (around 50% diminution).

Conclusions

The above results show that:

-   -   Contrary to SEV produced by human fibroblasts or by a highly         invasive breast cancer cell line, SEV produced by two low         invasive breast cancer cell lines are able to reduce the         invasion index of two highly invasive breast cancer cell lines         and a highly invasive melanoma cell line. This shows that SEV         produced by low invasive cancer cells may be used for reducing         cancer progression and metastasis.     -   Despite an absence of effect in vitro on invasive breast cancer         cell lines proliferation, SEV produced by a low invasive breast         cancer cell line were further found to impede both tumor growth         and metastasis in an in vivo xeno-transplantation model, further         demonstrating that SEV produced by low invasive cancer cells may         be used for reducing cancer progression and metastasis.     -   The inhibitory effect of SEV produced by a low invasive breast         cancer cell line T47D on the invasive capacity of highly         invasive cell lines (MDA-MB-231 and SUM-159-PT) requires the         expression of NFAT3 in the low invasive SEV-producing cells.     -   The expression of NFAT3 in the low invasive SEV-producing cells         results in de novo induction of TGFβ1 in highly invasive breast         cancer cell lines, which is required for the SEV to modulate         breast cancer cell invasion in vitro. In vivo, response to SEV         produced by a low invasive breast cancer cell line was found to         be correlated to TGFβ1 serum concentration. Increase of TGFβ1         concentration in patients administered with SEV produced by low         invasive cancer cells might thus be used as a biomarker of         therapeutic efficiency of the treatment.

Example 2: SEV Produced by Modified Autologous or Not Fibroblasts Inhibit Invasion

Since expression of NFAT3 by low invasive breast cancer cells has been found to be critical for SEV from these cells to inhibit cancer progression and metastasis, the ability of healthy fibroblasts induced to express NFAT3 to inhibit cancer progression and metastasis is further tested.

On this basis, a schematic diagram of the proposed therapy development is represented in FIG. 10.

Materials and Methods

Unless otherwise specified, for corresponding tests, the same protocols as in Example 1 are used.

Fibroblasts Isolation from Balbc Mice Skin.

Skin from shaved Balbc mice will be put in Dispase II (Sigma; #000000004942078001) overnight at 37° C. 5% CO2. 24 h after, dermis will be separated from the epidermis and dermis will be cut in very little parts and let it stick on a plastic culture plate. Then 10 ml of Dulbecco Modified Eagle Medium (DMEM), High glucose (4.5 g/L D-glucose), 10% Foetal Calf Serum will be added. Fibroblast will appear along the culture and will be amplified to be able to infect them with the different lentiviral construct described after.

Plasmids Construction

The human NFAT3 WT, NFAT3-85C, ΔNFAT3 WT, ΔNFAT3-85C were cloned by PCR using as a template plasmids already described (Fougère, M., et al. (2010). Oncogene, 29(15), 2292-2301) in fusion with the td Tomato tag in the pLVX-tdTomato-C1 plasmid from Clontech. All constructions were verified by sequencing.

The human CD63 was cloned by PCR using as a template a plasmid given by Dr Clothilde Thery from the Curie Institute in fusion with the td Tomato tag in the pLVX-tdTomato-C1 plasmid from Clontech. All constructions were verified by sequencing.

Cells were transiently transfected with the appropriate plasmids using Lipofectamine 2000 (Invitrogen) according to the manufacturer's instructions.

Sequences of the different constructions:

-   -   pLVX-tdTomato-C1 (Clonetech, empty vector): SEQ ID NO:28,         encoding protein tdTomato-C1 of sequence SEQ ID NO:34;     -   pLVX-tdTomato-C1-HA hNFAT3 WT (expression vector of isoform 2 of         NFATC4, as defined in Table 1 above): SEQ ID NO:29, encoding         protein tdTomato-C1 of sequence SEQ ID NO:35;     -   pLVX-tdTomato-C1-HA hNFAT3-85C (expression vector of isoform 2         of NFATC4, as defined in Table 1 above, truncated of the 85         C-terminal amino acids): SEQ ID NO:30, encoding protein         tdTomato-C1 of sequence SEQ ID NO:36;     -   pLVX-tdTomato-C1 htNFAT3 WT (expression vector of isoform 2 of         NFATC4, as defined in Table 1 above, truncated of the 521         N-terminal amino acids): SEQ ID NO:31, encoding protein         tdTomato-C1 of sequence SEQ ID NO:37;     -   pLVX-tdTomato-C1 htNFAT3-85C (expression vector of isoform 2 of         NFATC4, as defined in Table 1 above, truncated of the 521         N-terminal and 85 C-terminal amino acids): SEQ ID NO:32;     -   pLVX-tdTomato-C1-hCD63 (expression vector of hCD63): SEQ ID         NO:33.

Production of Lentiviral Particles in HEK293T Cells

The same protocol as described in Example 1 is used, excepted in step 2 of DAY 2:

Lentiviral Total Volume Transfer psPAX2 (with sterile Vector DNA pMD2G (env) (gag-pol) water) 100 cm2 22.5 ug 7.9 ug 14.6 945 ul

Example 3

Materials and Methods

Lentivirus Plasmid Construction

The following expression vectors of Example 2 has been used:

-   -   pLVX-tdTomato-C1 (Clonetech, empty vector, also referred to as         “to-Ctl”): SEQ ID NO:28, encoding protein tdTomato-C1 of         sequence SEQ ID NO:34;     -   pLVX-tdTomato-C1-HA hNFAT3 WT (expression vector of isoform 2 of         NFATC4, as defined in Table 1 above, also referred to as         “to-NFAT3 WT”): SEQ ID NO:29, encoding protein tdTomato-C1 of         sequence SEQ ID NO:35;     -   pLVX-tdTomato-C1-HA hNFAT3-85C (expression vector of isoform 2         of NFATC4, as defined in Table 1 above, truncated of the 85         C-terminal amino acids, also referred to as “to-NFAT3-85C”): SEQ         ID NO:30, encoding protein tdTomato-C1 of sequence SEQ ID NO:36;     -   pLVX-tdTomato-C1 htNFAT3 WT (expression vector of isoform 2 of         NFATC4, as defined in Table 1 above, truncated of the 521         N-terminal amino acids, also referred to as “to-ΔNFAT3”): SEQ ID         NO:31, encoding protein tdTomato-C1 of sequence SEQ ID NO:37;

Production of Lentiviral Particles in HEK293T Cells

-   -   DAY 1:

Plate cells in 10% SVF/HIGH DMEM

Cells number Volume medium 100 cm2 3.5 · 10⁶ 14 ml

-   -   DAY 2:

1—Plasmids transfection by phosphate calcium

For Lentiviral ORF Expression Vector

Lentiviral Transfer Vector Total (PLVX-toNFAT3, PLVX- Volume to-ΔNFAT3, PLVX- Trans-Lentiviral (with sterile toNFAT3-85C) Packaging Mix water) 100 cm2 42 ug 30 ul 945 ul

2—Add the indicated volume of CaCl2 to the diluted DNA above

CaCl2 100 cm2 15 ul

3—Vortex the tube at a speed sufficient to thoroughly mix reagents without spillover. While vortexing, add drop-wise the indicated volume of 2× HBSS:

2x HBSS 100 cm2 1050 ul

4—Incubate at room temperature for 3 minutes. A light chalky precipitate should appear during this incubation (the precipitate may not always be obvious).

5—Add the total volume (300 μt or 2.1 mL) of transfection mix drop-wise to the cells. (Note: The exact volume may be slightly less due to pipetting loss, but this will not negatively impact transfection effciency.)

6—Incubate cells at 37° C. with 5% CO2 for 10-16 hours

-   -   DAY 3:

1—Prepare reduced serum medium:

-   -   a. High Glucose DMEM     -   b. 5% Fetal Bovine     -   c. 2 mM L-glutamine     -   d. 1× Penicillin/Streptomycin

2—Remove calcium phosphate-containing medium from cells and replace 14 ml of reduced serum medium.

3—Incubate cells at 37° C. with 5% CO2 for an additional 48 hours.

-   -   DAY 5: Viral Particle Collection and Concentration

1—Harvest viral particle-containing supernatants 48 hours after the medium change by removing medium to a 15 mL sterile, capped, conical tube.

2—Pellet non-adherent cells and debris by centrifugation at 1600×g at 4° C. for 10 minutes to pellet cell debris.

3—Filtration step in which the supernatant is passed through a sterile, 0.22-0.45 μM low protein binding filter after the low-speed centrifugation step to remove any remaining cellular debris. Filtered viral medium is directly put in ultracentrifugation tube.

4—Concentrate by ultracentrifugation in a swinging-bucket ultracentrifuge rotor. Transfer the altered supernatant to a sterile ultracentrifuge tube. Bring volume to almost fill the tube to avoid braking tube during the ultra-centrifugation with DMEM containing no serum. For an SW28 rotor, centrifuge at 23,000 rpm for 2 hours at 4° C.

5—Pipette the desired resuspension volume of DMEM (no serum) onto the pellet at the bottom of the tube.

6—The visible pellet (if visible) is made up mostly of serum proteins from the culture media of the transfected cells. The viral particles need to be dislodged from this protein pellet. After adding the DMEM to the pellet, incubate for 10 minutes at 4° C. Then gently pipette up and down about 30 times, avoiding the formation of bubbles.

7—Transfer the resuspended pellet to a sterile microfuge tube and centrifuge at full speed for 3-4 minutes. This centrifugation will pellet the serum proteins, which adhere to the bottom of the tube. After centrifugation, transfer the supernatant to a new microfuge tube and aresuspend in 100 ul pf PBS (20 ul will be used per infection. Always store lentiviral particles at −80° C.

Infection of Cells with Lentiviral Particules and Selection

-   -   DAY 1:

Plate cells in 24 well plates in 10% SVF+AB in their corresponding medium

Cell type Cells number Volume medium HEK 293T 1.5 · 10⁵ 1 ml DMEM high

-   -   DAY 2:     -   1—Replace the medium with 250 ul of the corresponding medium         complemented with 4 ug/ml Polybrene     -   2—Infect by adding directly on the cells 20 ul of the virus     -   3—Let in the incubator for 4 h     -   4—After 4 h, add 1 ml/well of the corresponding medium         complemented with polybrene     -   DAY 6:     -   1—Trypsinyze the cell to transfer them in a 25 cm flask     -   DAY 9:     -   1. Bring the cell back in the lab and transfer them in:

Cell type Flask HEK 293T 150 cm

-   -   -   When the flask is confluent you can proceed to the sorting             of FACS

    -   CELL SORTING:

You should have a concentration for the sorting of 10. 10⁶ cells/ml

-   -   1. Trypsinize the cell and count them     -   2. Wash the cell one time in PBS     -   3. Resuspend the cell in the required volume of PBS completed         with 2× AB     -   4. Pass the cell on a cell strainer to eliminate aggregate     -   5. Transfer the cell Polypropylene Facs tubes     -   6. Prepare tube to receive the sorted cells containing 100% SVF         completed with 2× AB     -   7. Prepare 6 well plate to grow the sorted cells containing the         corresponding medium without SVF but with 2× AB (when the sorted         cells will be added there will be 20% SVF final)     -   8. Then let the cells grow until there is enough to realize the         different validation tests.     -   9. Don't forget to frost the clone.

Antibodies and Reagents

The following antibodies were used: Anti-CD63(#clone H5C6, BD Biosciences), anti-NFAT3 (Sigma; #F1804, Thermo Scientific; #PA1-021, Santa-Cruz Biotechnology; sc-13036), anti-CD9 (#clone CBL162, Millipore), anti-Actin (Thermo Scientific; #MA5-15739), anti-tdTomato (SICGENANTIBODIES; #AB8181-200).

Cells were transiently transfected with the appropriate plasmids using Lipofectamine 2000 (Invitrogen) or DharmaFECT (Dharmacon) for siRNA according to the manufacturer's instructions.

Results

HEK Cell Line Expresses Endogenous NFAT3, Like the T47D Breast Cancer Cell Line.

Inventors wanted to evaluate the possibility of using another cell line than MCF7 and T47D to test the possibility of transferring and enhancing the inhibitory capacity of SEV by overexpressing NFAT3 WT or NFAT3 mutants in a non-breast cancer cell line. To this end inventors have chosen the HEK cell line that is an easy growing and editable cell line. Inventors first evaluated the potential expression of endogenous NFAT3 by transiently transfecting them with either a non-targeting siRNA control (siCtl) or a siRNA targeting endogenous NFAT3 (siNFAT3). As a control, inventors used the T47D breast cancer cell line that expresses endogenous NFAT3.

Results are presented in FIG. 12 and show that HEK cell line expresses endogenous NFAT3 that is downregulated by siNFAT3 treatment as in T47D breast cancer cell line.

NFAT3 Mutants Used to Produce HEK Clone.

In FIG. 13A are depicted the different NFAT3 mutants fused to the tdTomato tag used to generate HEK clones. Either the wild type NFAT3 (NFAT3 WT), or the constitutively active NFAT3 mutant (ΔNFAT3) lacking the first 342 N-terminal amino acids or the inactive mutant (NFAT3-85C) deleted from its region necessary to inhibit the invasion was used.

Characterization of NFAT3 Overexpression in T47D Breast Cancer Cell Line.

T47D breast cancer cells were transiently transfected with either the control vector or with a vector expressing NFAT3 WT, ΔNFAT3, or NFAT3 lacking the last 85 C-terminal amino acids, and assessed for their invasive capacity in classical transwell invasion assay.

Results are presented in FIG. 13B and show that:

-   -   Overexpression of NFAT3 WT (NFAT3 WT) decreases by about 50% the         invasion index of T47D breast cancer cells compared to the cells         transfected with the empty vector (vector).     -   Overexpression of ΔNFAT3 (ΔNFAT3), the constitutively active         NFAT3 mutant, decreases to a better extent than NFAT3 WT by         about 70% the invasion index of T47D breast cancer cells         compared to the cells transfected with the empty vector         (vector).     -   Overexpression of NFAT3-85C (NFAT3-85C), the inactive mutant         deleted from its region necessary to inhibit the invasion, is no         longer able to decrease the invasion index compared to the         vector transfected cells (vector) and the NFAT3 WT or         ΔNFAT3-transfected cells.

Characterization of SEV Produced by HEK Cells Expressing to-Ctl, to-NFAT3 WT, to-ΔNFAT3 and to-NFAT3-85C

Representative examples of size distribution of SEV produced by HEK cells expressing to-Ctl, to-NFAT3 WT, to-ΔNFAT3 and to-NFAT3-85c are represented in FIG. 14A (HEK to-Ctl), FIG. 14B (HEK to-NFAT3 WT), FIG. 14C (HEK to-ΔNFAT3) and FIG. 14D (HEK to-NFAT3-85c) show that the SEV produced by the HEK clone have a similar mean size between 100 and 200 nm.

Generation of HEK Cell Lines Expressing NFAT3 WT and NFAT3 Mutants.

Inventors generated by lentiviral infection and puromycin selection stable HEK clones expressing to-Ctl, to-NFAT3 WT, to-ΔNFAT3 or to-NFAT3-85C.

Results are presented in FIG. 13C and show that HEK clones stably express to-Ctl, to-NFAT3 WT or to-ΔNFAT3, or to-NFAT3-85C.

SEV Produced by NFAT3-Overexpressing HEK Cells Inhibit Invasion of Highly Invasive Breast Cancer MDA-MB-231Cells, Pancreatic Cancer BXPC3 Cells, and Glioblastoma Cancer Cell to a Higher Extend that the SEV Produced in Cells Endogenously Expressing NFAT3, such as T47D Cells and HEK Cells Stably Infected with a Control Virus (HEK to-Ctl).

SEV from HEK cells stably infected with a control virus (HEK to-Ctl) or with a virus encoding NFAT3 WT (HEK to-NFAT3) or a constitutively active mutant of NFAT3 (HEK to-ΔNFAT3) or an inactive mutant of NFAT3 deleted from its last 85 C-terminal amino acids (HEK to-NFAT3-85C) were produced with the intent to test their specific capacity to modulate invasion of highly invasive breast cancer cells (MDA-MB-231, SUM-159-PT), pancreatic cancer cells (BXPC3) and glioblastoma cancer cells (U87MG) in classical transwell invasion assays. As a control, cells were treated with either PBS or SEV produced in the T47D breast cancer cell line.

Results are presented in FIG. 15 and show that:

-   -   SEV produced by the low invasive breast cancer cell line T47D         significantly decrease by about 40%-60% the invasion index of         all tested cell lines: highly invasive breast cancer cell lines         MDA-MB-231 (see FIG. 15A) and SUM-159-PT (see FIG. 15B),         pancreatic cell line BXPC3 (see FIG. 15C), and glioblastoma cell         line U87MG (see FIG. 15D).     -   SEV produced by HEK cell line infected with the control virus         (HEK to-Ctl) significantly decrease by about 40%-45% the         invasion index of highly invasive breast cancer cell lines         MDA-MB-231 (see FIG. 15A), and glioblastoma cell line U87MG (see         FIG. 15D), but not the invasion index of pancreatic cell line         BXPC3 (see FIG. 15C) and SUM-159-PT (see FIG. 15B).     -   These results are consistent with the fact that NFAT3 is         endogenously expressed by HEK cell line (see FIG. 12 showing         that targeting HEK cells with a siRNA targeting the endogenous         NFAT3 (siNFAT3) leads to a specific decreased of NFAT3         expression compared to HEK cells transfected with a siRNA         control (siCtl)).     -   SEV produced by HEK cell line infected with the virus encoding         NFAT3 WT (HEK to-NFAT3) significantly decrease by about 40%-60%         the invasion index of all tested cell lines: highly invasive         breast cancer cell lines MDA-MB-231 (see FIG. 15A) and         SUM-159-PT (see FIG. 15B), pancreatic cell line BXPC3 (see FIG.         15C), and glioblastoma cell line U87MG (see FIG. 15D).     -   This decrease tends to be higher than when the cancer cells are         treated with SEV produced either in the T47D cell line (see FIG.         15A for MDA-MB-231 and FIG. 15D for U87MG) or in the HEK to-Ctl         cell line (see FIG. 15B for SUM-159PT and FIG. 15C for BXPC3).     -   SEV produced by HEK cell line infected with the constitutively         active mutant of NFAT3 (HEK to-ΔNFAT3) significantly decrease by         about 60-80% the invasion index of all tested cell lines: highly         invasive breast cancer cell lines MDA-MB-231 (see FIG. 15A) and         SUM-159-PT (see FIG. 15B), and pancreatic cell lines BXPC3 (see         FIG. 15C), and glioblastoma cell line U87MG (see FIG. 15D).     -   This decrease is further higher than when the cancer cells are         treated with SEV produced in the HEK to-ΔNFAT3 cell line, for         all cancer cell lines in FIG. 15.     -   SEV produced by HEK cell line infected with an inactive mutant         of NFAT3 deleted from its last 85 C-terminal amino acids (HEK         to-NFAT3-85C) is no longer able to decrease the invasion index         of highly invasive breast cancer cell lines MDA-MB-231 (see FIG.         15A) and SUM-159-PT (see FIG. 15B), and pancreatic cell lines         BXPC3 (see FIG. 15C), and glioblastoma cell line U87MG (see FIG.         15D).

These results demonstrate again that the expression of NFAT3 (endogenous and/or exogenous) in SEV producing cells is absolutely required for the SEV to inhibit the invasion of breast, pancreatic and glioblastoma cancer cells. The strength of this inhibition can be enhanced by ectopic expression of a WT NFAT3 (HEK to-NFAT3). Moreover, this inhibition of invasion can be further enhanced (up to 80% of inhibition of the invasion index) by ectopic expression of a constitutively active mutant of NFAT3 (HEK to-ΔNFAT3). The specificity of the role of NFAT3 in the inhibition of the invasion index in all the cancer cell lines tested is demonstrated by the absence of inhibition of the invasion by SEV produced in HEK cell expressing an inactive mutant of NFAT3 deleted from its last 85 C-terminal amino acids (HEK to-NFAT3-85C).

These results further demonstrate that ectopic expression of NFAT3 in another cell line (HEK) is sufficient to transfer the inhibitory effect of NFAT3 in the SEV produced by this other cell line.

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The invention claimed is:
 1. A method for treating cancer or for treating metastatic cancer in a patient in need thereof, comprising administering to said patient a therapeutically efficient amount of a composition comprising secreted extracellular vesicles (SEV) of cells expressing the nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4 (NFATC4).
 2. The method according to claim 1, wherein said SEV of cells expressing NFATC4 are purified from cancer cells with low invasive capacity.
 3. The method according to claim 2, wherein said SEV of cells expressing NFATC4 are purified from breast cancer cells with low invasive capacity.
 4. The method according to claim 1, wherein said SEV of cells expressing NFATC4 are purified from cells transfected with an expression vector comprising a nucleic acid molecule encoding NFATC4.
 5. The method according to claim 4, wherein said cells transfected by the expression vector comprising the nucleic acid molecule encoding NFATC4 are selected from: cancer cells with low invasive capacity, and healthy cells.
 6. The method according to claim 5, wherein said healthy cells are autologous fibroblasts or human embryonic cells.
 7. The method according to claim 5, wherein said healthy cells are HEK293T cells.
 8. The method according to claim 1, wherein said cancer is selected from solid cancers.
 9. The method according to claim 8, wherein said solid cancer is selected from breast carcinoma, pancreatic carcinoma, and glioblastoma.
 10. The method according to claim 1, wherein said composition comprising SEV of cells expressing NFATC4 is administered intravenously or intratumorally.
 11. An in vitro method for determining the therapeutic efficiency of treatment with a composition comprising SEV of cells expressing nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4 (NFATC4) in a cancer patient, said method comprising: a) providing a first biological sample from said cancer patient taken before the beginning of the treatment and a second corresponding biological sample from said cancer patient after the beginning of the treatment; b) measuring the transforming growth factor beta 1 (TGFβ1) expression level in said first and second biological samples; c) comparing the measured TGFβ1 expression levels; and d) determining the efficiency of the treatment with the composition comprising SEV of cells expressing NFATC4 in said treated cancer patient from said comparison, wherein the treatment is determined efficient if the TGFβ1 expression level measured in the second biological sample is higher than the TGFβ1 expression level in the first biological sample.
 12. The method according to claim 11, wherein said biological sample is a tumor sample, a blood sample, a serum sample, or a urine sample.
 13. The method according to claim 11, wherein the expression level of TGFβ1 in the two biological samples of said cancer patient is measured at the nucleic acid level or at the protein level.
 14. The method according to claim 11, wherein said cancer is selected from solid cancers.
 15. The method according to claim 14, wherein said solid cancer is selected from breast carcinoma, pancreatic carcinoma, and glioblastoma.
 16. An in vitro method for predicting the therapeutic efficiency of treatment with a composition comprising SEV of cells expressing nuclear factor of activated T-cells, cytoplasmic, calcineurin-dependent 4 (NFATC4) in a cancer patient, said method comprising: a) providing a first biological sample and a second corresponding biological sample from said cancer patient taken before the beginning of the treatment; b) incubating the second biological sample with the composition comprising SEV of cells expressing NFATC4; c) measuring the transforming growth factor beta 1 (TGFβ1) expression level in said first and second biological samples; d) comparing the measured TGFβ1 expression levels; and e) predicting the efficiency of the treatment with the composition comprising SEV of cells expressing NFATC4 in said cancer patient from said comparison, wherein the treatment is predicted efficient if the TGFβ1 expression level measured in the second biological sample is higher than the TGFβ1 expression level in the first biological sample.
 17. The method according to claim 16, wherein said biological sample is a tumor sample, a blood sample, a serum sample, or a urine sample.
 18. The method according to claim 16, wherein the expression level of TGFβ1 in the two biological samples of said cancer patient is measured at the nucleic acid level or at the protein level.
 19. The method according to claim 16, wherein said cancer is selected from solid cancers.
 20. The method according to claim 19, wherein said solid cancer is selected from breast carcinoma, pancreatic carcinoma, and glioblastoma. 